Healthcare Provider Details

I. General information

NPI: 1689943599
Provider Name (Legal Business Name): MANDIE KAE MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 22ND ST
PARKERSBURG WV
26101-3429
US

IV. Provider business mailing address

1218 22ND ST
PARKERSBURG WV
26101-3429
US

V. Phone/Fax

Practice location:
  • Phone: 304-494-5184
  • Fax:
Mailing address:
  • Phone: 304-494-5184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: