Provider Demographics
NPI:1194776187
Name:MITCHELL, ADELE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ADELE
Middle Name:
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 1:607 TRADEWINDS DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-5318
Mailing Address - Country:US
Mailing Address - Phone:321-482-1607
Mailing Address - Fax:321-773-3844
Practice Address - Street 1:607 TRADEWINDS DR
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-5318
Practice Address - Country:US
Practice Address - Phone:321-482-1607
Practice Address - Fax:321-773-3844
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5672235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist