Provider Demographics
NPI:1780262709
Name:MANGIN HOEFLICH, EILEEN
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:MANGIN HOEFLICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8209 ASHWORTH AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4434
Mailing Address - Country:US
Mailing Address - Phone:425-324-8943
Mailing Address - Fax:
Practice Address - Street 1:1426 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-2534
Practice Address - Country:US
Practice Address - Phone:425-324-8943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC610194101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical