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NPI Code Detail

MEDICARE: ASHLEY JEAN MANGABAT M.S., CCC-SLP

MEDICARE: ASHLEY JEAN MANGABAT 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
1235Z00000XSpeech-Language Pathologist17816CA

General Provider Information

NPI Number : 1578899696
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY JEAN MANGABAT M.S., CCC-SLP
Provider Business Mailing Address
First Line : 1612 WASHINGTON AVE
Second Line :
City : SAN JACINTO
State : CA
Zip : 92583-5728
Country : US
Telephone Number : 951-282-8403
Fax Number :
Provider Business Practice Location Address
First Line : 2701 N ROCKY POINT DR
Second Line : SUITE 650
City : TAMPA
State : FL
Zip : 33607-5917
Country : US
Telephone Number : 800-892-0640
Fax Number : 800-892-0648
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2009
Last Update Date : 10/23/2009

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Directions to “ ASHLEY JEAN MANGABAT M.S., CCC-SLP” Practice Location

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