Healthcare Provider Details

I. General information

NPI: 1922293216
Provider Name (Legal Business Name): ASHLEY B. MITCHELL M.S., C.C.C., S.L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 I 55 N SUITE 291, HIGHLAND VILLAGE
JACKSON MS
39211-5930
US

IV. Provider business mailing address

4500 I 55 N SUITE 291, HIGHLAND VILLAGE
JACKSON MS
39211-5930
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-0859
  • Fax:
Mailing address:
  • Phone: 601-362-0859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS3005
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: