Healthcare Provider Details

I. General information

NPI: 1033044037
Provider Name (Legal Business Name): KATELYN MITCHELL AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 CHARLES ST
BOSTON MA
02114-3096
US

IV. Provider business mailing address

650 OCEAN AVE UNIT 423
REVERE MA
02151-1373
US

V. Phone/Fax

Practice location:
  • Phone: 617-573-3266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD100225
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: