Individual
JENNIFER MANGRUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14100 PAGE ST, WOODBRIDGE, VA 22191-2608
(703) 494-3252
Mailing address
14715 BRISTOW RD, MANASSAS, VA 20112-3945
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202006150
VA
Other
Enumeration date
05/08/2018
Last updated
05/08/2018
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