Basic Information
| Provider Information | |||||||||
| NPI: | 1578899696 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANGABAT | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.S., CCC-SLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SEDERSTEN | ||||||||
| OtherFirstName: | ASHLEY | ||||||||
| OtherMiddleName: | JEAN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1612 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | SAN JACINTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925835728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512828403 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2701 N ROCKY POINT DR | ||||||||
| Address2: | SUITE 650 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336075917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008920640 | ||||||||
| FaxNumber: | 8008920648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2009 | ||||||||
| LastUpdateDate: | 10/23/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 17816 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.