Provider Demographics
NPI:1407139983
Name:MANGANO, AMY (SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MANGANO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 OLIVETTE EXECUTIVE PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3252
Mailing Address - Country:US
Mailing Address - Phone:314-432-6200
Mailing Address - Fax:314-432-8864
Practice Address - Street 1:1101 OLIVETTE EXECUTIVE PKWY
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-3252
Practice Address - Country:US
Practice Address - Phone:314-432-6200
Practice Address - Fax:314-432-8864
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist