Individual
CONNIE WEST MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,CCC-SLP
Contact information
Practice address
2823 ARLINGTON AVE, FAYETTEVILLE, NC 28303-5403
(910) 483-4002
(910) 483-8462
Mailing address
2900 WESTON CIR, FAYETTEVILLE, NC 28306-2560
(910) 426-5361
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2463
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
53812
BCBS PROVIDER #
NC
05
—
7412046
—
NC
Enumeration date
06/21/2006
Last updated
07/09/2007
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