Healthcare Provider Details

I. General information

NPI: 1629089487
Provider Name (Legal Business Name): AMIE MANGINE DEAN M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMIE REBECCA MANGINE M.S., CCC-SLP

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 PANTHER CROSSING
BULLARD TX
75757
US

IV. Provider business mailing address

1426 B S HOUSTON STREET
BULLARD TX
75757
US

V. Phone/Fax

Practice location:
  • Phone: 903-894-2930
  • Fax: 281-494-0655
Mailing address:
  • Phone: 903-894-2930
  • Fax: 281-494-0655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number100357
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: