Provider Demographics
NPI:1598991069
Name:MANGAN, JAIME L (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:L
Last Name:MANGAN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MS
Other - First Name:JAIME
Other - Middle Name:L
Other - Last Name:TAUSSIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:12 KENT PL
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-4035
Mailing Address - Country:US
Mailing Address - Phone:631-532-6973
Mailing Address - Fax:
Practice Address - Street 1:12 KENT PL
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-4035
Practice Address - Country:US
Practice Address - Phone:631-532-6973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017285-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist