Healthcare Provider Details

I. General information

NPI: 1497274450
Provider Name (Legal Business Name): KATIE ANN MITCHELL MSW, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 IL ROUTE 2
DIXON IL
61021-9118
US

IV. Provider business mailing address

325 IL ROUTE 2
DIXON IL
61021-9118
US

V. Phone/Fax

Practice location:
  • Phone: 815-284-6611
  • Fax: 815-284-6598
Mailing address:
  • Phone: 815-284-6611
  • Fax: 815-284-6598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: