Individual
ANGELA NICOLE MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
634 N MAIN ST STE 4, O FALLON, IL 62269-3746
(618) 726-5870
Mailing address
21600 OXNARD ST # ARE1800, WOODLAND HILLS, CA 91367-4976
(818) 345-2345
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
M52501485731
IL
Other
Enumeration date
02/13/2018
Last updated
02/13/2018
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