Provider Demographics
NPI:1043946957
Name:MAMROSH, LELA ANGELINE
Entity Type:Individual
Prefix:
First Name:LELA
Middle Name:ANGELINE
Last Name:MAMROSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 BECKYS WAY
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-4330
Mailing Address - Country:US
Mailing Address - Phone:512-934-1343
Mailing Address - Fax:
Practice Address - Street 1:3001 BOXER RD
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2103
Practice Address - Country:US
Practice Address - Phone:808-707-0266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist