Provider Demographics
NPI:1750168142
Name:MITTON, JOHANNE (CF-SLP)
Entity type:Individual
Prefix:
First Name:JOHANNE
Middle Name:
Last Name:MITTON
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9046 205TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2731
Mailing Address - Country:US
Mailing Address - Phone:347-755-2436
Mailing Address - Fax:
Practice Address - Street 1:9046 205TH ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2731
Practice Address - Country:US
Practice Address - Phone:347-755-2436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist