Provider Demographics
NPI:1124846688
Name:MITCHELL, SKYLER (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:SKYLER
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 GLENROTHS DR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1604
Mailing Address - Country:US
Mailing Address - Phone:951-970-2805
Mailing Address - Fax:
Practice Address - Street 1:810 EDMUND ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-3546
Practice Address - Country:US
Practice Address - Phone:410-273-5530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120165235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120165OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION
14476289OtherAMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION