Healthcare Provider Details

I. General information

NPI: 1790366839
Provider Name (Legal Business Name): MERCEDES CLINET MITCHELL MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 N WESTWOOD AVE
TOLEDO OH
43607-3286
US

IV. Provider business mailing address

1456 PINEWOOD AVE
TOLEDO OH
43607-4064
US

V. Phone/Fax

Practice location:
  • Phone: 419-973-7799
  • Fax:
Mailing address:
  • Phone: 419-973-7799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number3654155
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: