Provider Demographics
NPI:1740650530
Name:MITCHELL, JOSIE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:IL
Mailing Address - Zip Code:61859-0374
Mailing Address - Country:US
Mailing Address - Phone:765-761-3997
Mailing Address - Fax:
Practice Address - Street 1:105 W PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:IL
Practice Address - Zip Code:61859-8808
Practice Address - Country:US
Practice Address - Phone:765-761-3997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0198041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1255052866Medicaid