Individual
MR. COLIN KENNETH MANDIGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
2880 MISSION DR, SHELBYVILLE, MI 49344-9580
(269) 397-1760
(269) 397-1761
Mailing address
2880 MISSION DR, SHELBYVILLE, MI 49344-9580
(269) 397-1760
(269) 397-1761
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801115066
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6801115066
LARA BOARD OF SOCIAL WORK MASTERS SOCIAL WORKER LICENSE CLINICAL
MI
Enumeration date
06/27/2019
Last updated
07/16/2025
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