Provider Demographics
NPI:1831686864
Name:MITCHELL, ERIN DANIELLE
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:DANIELLE
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 1:245 NEIL AVE
Mailing Address - Street 2:
Mailing Address - City:MT. GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-9372
Mailing Address - Country:US
Mailing Address - Phone:419-946-6734
Mailing Address - Fax:
Practice Address - Street 1:245 NEIL AVE
Practice Address - Street 2:
Practice Address - City:MT. GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-9372
Practice Address - Country:US
Practice Address - Phone:419-946-6734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH171M00000XMedicaid