Provider Demographics
NPI:1063624955
Name:MITCHELL, JOANNE R (M ED)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:R
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091
Mailing Address - Country:US
Mailing Address - Phone:859-384-1828
Mailing Address - Fax:
Practice Address - Street 1:4210 BEAVER RD
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091
Practice Address - Country:US
Practice Address - Phone:859-384-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY60421952171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor