Provider Demographics
NPI:1376168062
Name:MANGENE, ERIN (CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MANGENE
Suffix:
Gender:F
Credentials:CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 EAST ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4083
Mailing Address - Country:US
Mailing Address - Phone:585-683-3110
Mailing Address - Fax:
Practice Address - Street 1:33 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:FAIR HAVEN
Practice Address - State:VT
Practice Address - Zip Code:05743-1048
Practice Address - Country:US
Practice Address - Phone:802-265-4966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT144.0134350235Z00000X
VT144.0134256-PROV235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist