Provider Demographics
NPI:1457784027
Name:MANGAN, KATHLEEN S
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:S
Last Name:MANGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 W KENT AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6619
Mailing Address - Country:US
Mailing Address - Phone:406-880-2639
Mailing Address - Fax:406-721-0055
Practice Address - Street 1:825 W KENT AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6619
Practice Address - Country:US
Practice Address - Phone:406-880-2639
Practice Address - Fax:406-721-0055
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-18
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator