Provider Demographics
NPI:1629104054
Name:MANTINI, GLORIA J (LICENSED SLP)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:J
Last Name:MANTINI
Suffix:
Gender:F
Credentials:LICENSED SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1909 N RIDGE RD E
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-3379
Mailing Address - Country:US
Mailing Address - Phone:440-277-7337
Mailing Address - Fax:440-277-7339
Practice Address - Street 1:1909 N RIDGE RD E
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-3379
Practice Address - Country:US
Practice Address - Phone:440-277-7337
Practice Address - Fax:440-277-7339
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-1591235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist