MEDICARE: MRS. MANDY CASE M.A.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	102313	TX
2	235Z00000X	Speech-Language Pathologist	17756	CA

General Provider Information

NPI Number	:	1932348893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MANDY CASE M.A.CCC/SLP

Provider Business Mailing Address
First Line	:	5151 MURPHY CANYON RD
Second Line	:	SUITE 150
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4440
Country	:	US
Telephone Number	:	619-275-4525
Fax Number	:	619-275-4526

Provider Business Practice Location Address
First Line	:	5151 MURPHY CANYON RD
Second Line	:	SUITE 150
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4440
Country	:	US
Telephone Number	:	619-275-4525
Fax Number	:	619-275-4526

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

Provider Enumeration Date	:	02/16/2009
Last Update Date	:	03/01/2010

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