Provider Demographics
NPI:1780238121
Name:MANGIALARDI, ALLISON (AUD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:MANGIALARDI
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:HINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7675 WOLF RIVER CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1748
Mailing Address - Country:US
Mailing Address - Phone:901-682-1529
Mailing Address - Fax:901-761-0592
Practice Address - Street 1:7675 WOLF RIVER CIR STE 101
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1748
Practice Address - Country:US
Practice Address - Phone:901-682-1529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1878231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist