Provider Demographics
NPI:1396186573
Name:MANGIORE, RACHAEL JEANETTE (AUD)
Entity Type:Individual
Prefix:MS
First Name:RACHAEL
Middle Name:JEANETTE
Last Name:MANGIORE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-7509
Mailing Address - Fax:314-362-7522
Practice Address - Street 1:1044 N MASON RD
Practice Address - Street 2:DEPT OTOLARYNGOLOGY, STE L20
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6431
Practice Address - Country:US
Practice Address - Phone:314-362-7509
Practice Address - Fax:314-362-7522
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013027474231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO330017349Medicaid