Provider Demographics
NPI:1841921475
Name:MITCHELL, CHRISTINA GAIL (MS,CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:GAIL
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 1:2003 STAPP DR UNIT C
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-1601
Mailing Address - Country:US
Mailing Address - Phone:270-832-8667
Mailing Address - Fax:
Practice Address - Street 1:2003 STAPP DR UNIT C
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-1601
Practice Address - Country:US
Practice Address - Phone:270-832-8667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12036944235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist