Provider Demographics
NPI:1437362134
Name:MITCHUM, CHARLOTTE C (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:C
Last Name:MITCHUM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 CHANTAWAY CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6193
Mailing Address - Country:US
Mailing Address - Phone:410-515-0389
Mailing Address - Fax:
Practice Address - Street 1:2225 OLD EMMORTON RD
Practice Address - Street 2:SUITE 210
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6129
Practice Address - Country:US
Practice Address - Phone:410-515-4900
Practice Address - Fax:410-515-0777
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01348235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist