Provider Demographics
NPI:1699082461
Name:MITCHELL, MARILYN
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:
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 1:67 JOHNSON HTS
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4908
Mailing Address - Country:US
Mailing Address - Phone:207-873-5422
Mailing Address - Fax:
Practice Address - Street 1:577 MOUNT VIEW RD
Practice Address - Street 2:
Practice Address - City:THORNDIKE
Practice Address - State:ME
Practice Address - Zip Code:04986-3307
Practice Address - Country:US
Practice Address - Phone:207-568-4609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1499235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MESP1499OtherMAINECARE