Individual
MRS. KRISTIN HAINES MANGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
707 SW GAINES ST, PORTLAND, OR 97239-2901
(800) 452-3563
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-9045
(503) 418-5203
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12642
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
270054
—
OR
Enumeration date
08/03/2006
Last updated
07/08/2009
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