Individual
ERICA D MBANGAMOH
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
3915 GOLDEN VALLEY RD, COURAGE CENTER, GOLDEN VALLEY, MN 55422-4298
(763) 520-0419
(763) 520-0355
Mailing address
3915 GOLDEN VALLEY RD, COURAGE CENTER, GOLDEN VALLEY, MN 55422-4298
(763) 520-0419
(763) 520-0355
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7937
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
434M7MB
BCBS MINNESOTA
—
01
—
HP55736
HEALTH PARTNERS
—
Enumeration date
04/21/2006
Last updated
07/08/2007
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