Healthcare Provider Details

I. General information

NPI: 1508404294
Provider Name (Legal Business Name): PAULA MITCHELL CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2429 WESTPORT DR
NORMAN OK
73069-6337
US

IV. Provider business mailing address

3930 INDIAN POINT CIR
NORMAN OK
73026-8634
US

V. Phone/Fax

Practice location:
  • Phone: 405-308-9120
  • Fax: 405-928-5530
Mailing address:
  • Phone: 918-852-7208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4475
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: