Provider Demographics
NPI:1912397076
Name:MANGAN, ERIKA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:MANGAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 21ST AVE S STE 6209
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-0014
Mailing Address - Country:US
Mailing Address - Phone:615-322-5021
Mailing Address - Fax:615-875-1411
Practice Address - Street 1:1215 21ST AVE S STE 6209
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0014
Practice Address - Country:US
Practice Address - Phone:615-322-5021
Practice Address - Fax:615-875-1411
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5229235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist