Provider Demographics
NPI:1740461987
Name:MANGOLD, LORRAINE S (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:S
Last Name:MANGOLD
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:PO BOX 166
Mailing Address - Street 2:NEW CREEK SCHOOL ROAD
Mailing Address - City:NEW CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26743-0166
Mailing Address - Country:US
Mailing Address - Phone:304-788-4031
Mailing Address - Fax:
Practice Address - Street 1:ONE BAKER PLACE
Practice Address - Street 2:MINERAL COUNTY BOARD OF EDUCATION
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726
Practice Address - Country:US
Practice Address - Phone:304-298-3632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0130235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist