Basic Information
| Provider Information | |||||||||
| NPI: | 1073854907 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | MARYANN | ||||||||
| MiddleName: | P. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.A. SLP-CFY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5447 WOODWARD AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482024009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138321100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19505 E 8 MILE RD | ||||||||
| Address2: | |||||||||
| City: | SAINT CLAIR SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480801643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138321100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2013 | ||||||||
| LastUpdateDate: | 03/01/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 7101000474 | MI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.