Provider Demographics
NPI:1679351829
Name:MITCHELL, RENAE ROSE
Entity type:Individual
Prefix:
First Name:RENAE
Middle Name:ROSE
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 1:19300 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ROCA
Mailing Address - State:NE
Mailing Address - Zip Code:68430-4239
Mailing Address - Country:US
Mailing Address - Phone:402-419-4491
Mailing Address - Fax:
Practice Address - Street 1:320 N 5TH ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-2957
Practice Address - Country:US
Practice Address - Phone:402-223-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist