Provider Demographics
NPI:1932348893
Name:CASE, MANDY (MACCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:
Last Name:CASE
Suffix:
Gender:F
Credentials:MACCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 MURPHY CANYON RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4440
Mailing Address - Country:US
Mailing Address - Phone:619-275-4525
Mailing Address - Fax:619-275-4526
Practice Address - Street 1:5151 MURPHY CANYON RD
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4440
Practice Address - Country:US
Practice Address - Phone:619-275-4525
Practice Address - Fax:619-275-4526
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102313235Z00000X
CA17756235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist