Healthcare Provider Details

I. General information

NPI: 1558697276
Provider Name (Legal Business Name): ANN M MIXON MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 FAIRMOUNT BLVD
GARDEN CITY NY
11530-5130
US

IV. Provider business mailing address

60 FAIRMOUNT BLVD
GARDEN CITY NY
11530-5130
US

V. Phone/Fax

Practice location:
  • Phone: 516-616-0302
  • Fax: 516-437-0420
Mailing address:
  • Phone: 516-616-0302
  • Fax: 516-437-0420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number018811-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: