MEDICARE: CHRISTINE DIAN MANTCHEV M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	118830	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	118830	OTHER	TX	TDLR

General Provider Information

NPI Number	:	1043918733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE DIAN MANTCHEV M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	5606 FIRESIDE DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-1123
Country	:	US
Telephone Number	:	682-351-7962
Fax Number	:

Provider Business Practice Location Address
First Line	:	5606 FIRESIDE DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-1123
Country	:	US
Telephone Number	:	682-351-7962
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2023
Last Update Date	:	02/21/2023

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Directions to “ CHRISTINE DIAN MANTCHEV M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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