Provider Demographics
NPI:1639379373
Name:SANGHA, MANDY LEE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:LEE
Last Name:SANGHA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:MANDY
Other - Middle Name:LEE
Other - Last Name:FIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1096 MILO CIR UNIT A
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3084
Mailing Address - Country:US
Mailing Address - Phone:312-835-6665
Mailing Address - Fax:
Practice Address - Street 1:1096 MILO CIR UNIT A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3084
Practice Address - Country:US
Practice Address - Phone:312-835-6665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008812235Z00000X
COSLP.0002544235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist