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NPI Code Detail

MEDICARE: LISA S KIRBY-MANGAS MS, CCC

MEDICARE: LISA S KIRBY-MANGAS MS, CCC
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 Pathologist4340-154WI

General Provider Information

NPI Number : 1689526923
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA S KIRBY-MANGAS MS, CCC
Provider Business Mailing Address
First Line : 1510 MIDDLETON ST
Second Line :
City : MIDDLETON
State : WI
Zip : 53562-3722
Country : US
Telephone Number : 608-663-8474
Fax Number :
Provider Business Practice Location Address
First Line : 545 W DAYTON ST
Second Line :
City : MADISON
State : WI
Zip : 53703-1995
Country : US
Telephone Number : 608-663-8474
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2026
Last Update Date : 02/10/2026

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Directions to “ LISA S KIRBY-MANGAS MS, CCC” Practice Location

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