Provider Demographics
NPI:1336947530
Name:MITCHELL, STACIE R (DOULA)
Entity type:Individual
Prefix:MS
First Name:STACIE
Middle Name:R
Last Name:MITCHELL
Suffix:
Gender:
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 PERSHING BLVD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-3505
Mailing Address - Country:US
Mailing Address - Phone:262-620-1470
Mailing Address - Fax:
Practice Address - Street 1:900 E 162ND ST
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2471
Practice Address - Country:US
Practice Address - Phone:708-331-8111
Practice Address - Fax:708-331-8088
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula