Provider Demographics
NPI:1487897203
Name:MITCHELL, KATHERINE ANN
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1848 TWIN RIVERS RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-2101
Mailing Address - Country:US
Mailing Address - Phone:931-561-3438
Mailing Address - Fax:
Practice Address - Street 1:2150 WILMA RUDOLPH BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6675
Practice Address - Country:US
Practice Address - Phone:931-542-2168
Practice Address - Fax:931-542-2206
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1494235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist