Basic Information
| Provider Information | |||||||||
| NPI: | 1669420105 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | M.A. CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 9TH ST SE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559046425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5075296610 | ||||||||
| FaxNumber: | 5075296622 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 9TH ST SE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559046425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5075296610 | ||||||||
| FaxNumber: | 5075296622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 07/06/2016 | ||||||||
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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 | 231H00000X | 3501004466 | MI | N | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | 8083 | MN | Y | Speech, Language and Hearing Service Providers | Audiologist | 231HA2400X | 8083 | MN | N | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Practitioner | 231HA2500X | 8083 | MN | N | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Supplier | 237600000X | 8083 | MN | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | 4697574 | 05 | MI | MEDICAID |