Provider Demographics
NPI:1962123695
Name:MIZELLE, CAITLYN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:MIZELLE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 CHOCTAW BND
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-3164
Mailing Address - Country:US
Mailing Address - Phone:601-951-7640
Mailing Address - Fax:
Practice Address - Street 1:115 AULENBROCK DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-7061
Practice Address - Country:US
Practice Address - Phone:601-521-4934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist