Provider Demographics
NPI:1588367049
Name:MITZEL, JONI ANN
Entity type:Individual
Prefix:
First Name:JONI
Middle Name:ANN
Last Name:MITZEL
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 1:307 W LINE ST
Mailing Address - Street 2:
Mailing Address - City:MINERVA
Mailing Address - State:OH
Mailing Address - Zip Code:44657-1911
Mailing Address - Country:US
Mailing Address - Phone:330-323-2715
Mailing Address - Fax:
Practice Address - Street 1:307 W LINE ST
Practice Address - Street 2:
Practice Address - City:MINERVA
Practice Address - State:OH
Practice Address - Zip Code:44657-1911
Practice Address - Country:US
Practice Address - Phone:330-323-2715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker