| Doctor Name: | MARION JACKSON MITO |
| NPI Number: | 1912219890 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A. CCC-SLP |
| License Number: | 146.001757 |
| Business Practice Address: | 1875 Dempster St Parkside G-10 Park Ridge, IL - 600681186 |
| Business Phone Number: | 8477237848 |
| Business Fax Number: | 8477232223 |
| Mailing Address: | 2616 N Wilshire Ln, ARLINGTON HEIGHTS |
| State: | IL |
| Postal Code: | 600042275 |
| Phone Number: | 8472532278 |
| Fax Number: | 8472532278 |
| NPI Enumeration Date: | 07/08/2010 |
| NPI Last Update Date: | 07/08/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 146.001757 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |