Most Relevant Information
Provider Data
| NPI Number: | 1003435553 |
| Provider Name: | SAVANNAH MANGRUM |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/14/2020 |
| Last Updated: | 04/14/2020 |
Provider Practice Location
2138 FAWNS CREEK XING
MT JULIET
TN
371221207
Practice Location Phone/Fax
| Phone: | 6158668922 |
| Fax: |
Provider Mailing Location
306 N KENSINGTON AVE
LA GRANGE PARK
IL
605261870
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |