Individual
SHANAIL ANNETTE MANGRUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
12/18/2015
Contact information
Practice address
1250 PARKWAY PL APT F, CLARKSVILLE, TN 37042-8479
(907) 347-0286
Mailing address
1250 PARKWAY PL APT F, CLARKSVILLE, TN 37042-8479
(907) 347-0286
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-15-10015
TN
Other
Enumeration date
03/22/2017
Last updated
03/22/2017
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