Individual
EMILY MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
2046 MEADOWBROOK RD, JACKSON, MS 39211-6527
(601) 953-7697
Mailing address
212 SYCAMORE LN, MADISON, MS 39110-7460
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S4542
MS
Other
Enumeration date
09/27/2019
Last updated
10/29/2019
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