Provider Demographics
NPI:1669420105
Name:MITCHELL, DONNA M (MA CCC-A)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 9TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-6425
Mailing Address - Country:US
Mailing Address - Phone:507-529-6610
Mailing Address - Fax:507-529-6622
Practice Address - Street 1:210 9TH ST SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-6425
Practice Address - Country:US
Practice Address - Phone:507-529-6610
Practice Address - Fax:507-529-6622
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501004466231H00000X
MN8083231HA2400X, 231HA2500X, 237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4697574Medicaid
MI4697574Medicaid
MIM25090006Medicare ID - Type UnspecifiedWA FOOTE MEMORIAL