Provider Demographics
NPI:1104961028
Name:MITCHELL, LAURA ALICE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ALICE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 65A9
Mailing Address - Street 2:
Mailing Address - City:BEARDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71720-9404
Mailing Address - Country:US
Mailing Address - Phone:870-313-1031
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 65A9
Practice Address - Street 2:
Practice Address - City:BEARDEN
Practice Address - State:AR
Practice Address - Zip Code:71720-9404
Practice Address - Country:US
Practice Address - Phone:870-313-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR#598235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist