Provider Demographics
NPI:1528484714
Name:MITCHELL, MELISSA (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MA, 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:PO BOX 9000
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-0900
Mailing Address - Country:US
Mailing Address - Phone:555-259-4878
Mailing Address - Fax:
Practice Address - Street 1:PASEO DE LOS LAURELES 404
Practice Address - Street 2:1205
Practice Address - City:MEXICO CITY
Practice Address - State:MEXICO
Practice Address - Zip Code:05100
Practice Address - Country:MX
Practice Address - Phone:555-259-4878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2203000201235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist