Provider Demographics
NPI:1841449865
Name:MITCHELL, CHERYL SCOTT (MS CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:SCOTT
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9530 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34951-2934
Mailing Address - Country:US
Mailing Address - Phone:772-216-2530
Mailing Address - Fax:
Practice Address - Street 1:210 S INDIAN RIVER DR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4337
Practice Address - Country:US
Practice Address - Phone:772-461-7689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7379235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist