Provider Demographics
NPI:1801073911
Name:MITCHELL, KINE IMANI (MA)
Entity type:Individual
Prefix:MRS
First Name:KINE
Middle Name:IMANI
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:KINE
Other - Middle Name:IMANI
Other - Last Name:BREMBRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1966 INWOOD RD.
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235
Mailing Address - Country:US
Mailing Address - Phone:214-905-3000
Mailing Address - Fax:214-905-3022
Practice Address - Street 1:1966 INWOOD RD.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235
Practice Address - Country:US
Practice Address - Phone:214-905-3000
Practice Address - Fax:214-905-3022
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013296235Z00000X
TX105671235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist