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NPI Code Detail

MEDICARE: JENNIFER H MITCHELL MS CCC-SLP

MEDICARE: JENNIFER H MITCHELL MS CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist5906NC

General Provider Information

NPI Number : 1790980373
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER H MITCHELL MS CCC-SLP
Provider Business Mailing Address
First Line : 607 CATALINA DR
Second Line :
City : GREENSBORO
State : NC
Zip : 27403-1236
Country : US
Telephone Number : 336-292-6368
Fax Number :
Provider Business Practice Location Address
First Line : 6100 W FRIENDLY AVE
Second Line :
City : GREENSBORO
State : NC
Zip : 27410-4160
Country : US
Telephone Number : 336-292-1301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2007
Last Update Date : 07/08/2007

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