Provider Demographics
NPI:1194849992
Name:MITLEHNER, PATRICIA LYNN GABRIELLE (MS CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:PATRICIA LYNN
Middle Name:GABRIELLE
Last Name:MITLEHNER
Suffix:
Gender:F
Credentials:MS CCC-SLP
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Mailing Address - Street 1:5983 BROOK CLIFF PL
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-4602
Mailing Address - Country:US
Mailing Address - Phone:704-795-1029
Mailing Address - Fax:704-792-9198
Practice Address - Street 1:1065 VINEHAVEN DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2439
Practice Address - Country:US
Practice Address - Phone:704-786-9181
Practice Address - Fax:704-792-9198
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC4026235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10113OtherBCBS