Provider Demographics
NPI:1083888697
Name:RAISCH, MANDY LEIGH (AUD)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:LEIGH
Last Name:RAISCH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 BOILING SPRINGS RD
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-4201
Mailing Address - Country:US
Mailing Address - Phone:864-278-1446
Mailing Address - Fax:
Practice Address - Street 1:110 B TOWN COMMONS DRIVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-2815
Practice Address - Country:US
Practice Address - Phone:704-313-0204
Practice Address - Fax:704-313-0194
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5852231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7413157Medicaid
NC2696768OtherMEDICARE