Provider Demographics
NPI:1831454172
Name:MITCHELL, ASHLIE KRISTINA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ASHLIE
Middle Name:KRISTINA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:ASHLIE
Other - Middle Name:KRISTINA
Other - Last Name:MCNICOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:34 BEN LOUIS DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5712
Mailing Address - Country:US
Mailing Address - Phone:618-780-9880
Mailing Address - Fax:
Practice Address - Street 1:34 BEN LOUIS DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5712
Practice Address - Country:US
Practice Address - Phone:618-780-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010374235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist