Healthcare Provider Details

I. General information

NPI: 1952529885
Provider Name (Legal Business Name): DANIELLE CAREY MITCHELL MS CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9240 COUNTY VIEW RD
DALLAS TX
75249-1124
US

IV. Provider business mailing address

114 COUNTRY RIDGE CT
RED OAK TX
75154-3931
US

V. Phone/Fax

Practice location:
  • Phone: 972-708-2060
  • Fax:
Mailing address:
  • Phone: 972-948-1546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number100941
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: