Individual
EDWARD MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2405 NORTHWESTERN AVE # LL15, RACINE, WI 53404-2534
(262) 260-8370
(262) 260-8358
Mailing address
2405 NORTHWESTERN AVE # LL15, RACINE, WI 53404-2534
(262) 260-8370
(262) 260-8358
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
15732-131
WI
Other
Enumeration date
05/21/2014
Last updated
05/21/2014
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