Healthcare Provider Details

I. General information

NPI: 1023262664
Provider Name (Legal Business Name): MAGGIE MITCHELL SLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E PARKER ST
HAMBURG AR
71646-3399
US

IV. Provider business mailing address

202 E PARKER ST
HAMBURG AR
71646-3244
US

V. Phone/Fax

Practice location:
  • Phone: 870-853-2836
  • Fax:
Mailing address:
  • Phone: 870-853-2864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355A2700X
TaxonomyAudiology Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number916874019
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: