Provider Demographics
NPI:1588427967
Name:MITCHELL, SHANNON C (SLPA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:C
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GAVILAN
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-1600
Mailing Address - Country:US
Mailing Address - Phone:949-842-6931
Mailing Address - Fax:
Practice Address - Street 1:22672 LAMBERT ST STE 611
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1613
Practice Address - Country:US
Practice Address - Phone:949-329-8161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA50242355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant