Provider Demographics
NPI:1073873642
Name:HART, MANDY SUSAN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MANDY
Middle Name:SUSAN
Last Name:HART
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 TULSA LN
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2337
Mailing Address - Country:US
Mailing Address - Phone:301-530-6021
Mailing Address - Fax:
Practice Address - Street 1:6310 TULSA LN
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-2337
Practice Address - Country:US
Practice Address - Phone:301-530-6021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1575235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist