Provider Demographics
NPI:1730808775
Name:MITCHELL, ALYSSA M (MS)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:M
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8697 S BEN ROWE CIR
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-5117
Mailing Address - Country:US
Mailing Address - Phone:904-553-9782
Mailing Address - Fax:
Practice Address - Street 1:8697 S BEN ROWE CIR
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-5117
Practice Address - Country:US
Practice Address - Phone:904-553-9782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA22624235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist