Doctor Name: | JENNIFER MITCHELL |
NPI Number: | 1083912307 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D, BCBA-D |
License Number: | |
Business Practice Address: | 5242 S 4820 W Kearns, UT - 841186422 |
Business Phone Number: | 8019664251 |
Business Fax Number: | 8019664289 |
Mailing Address: | 350 S 400 E, SALT LAKE CITY |
State: | UT |
Postal Code: | 841112908 |
Phone Number: | 8015825534 |
Fax Number: | 8015825540 |
NPI Enumeration Date: | 03/10/2011 |
NPI Last Update Date: | 10/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |