| Doctor Name: | MRS. KRISTIN HAINES MANGAN |
| NPI Number: | 1215945753 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CCC-SLP |
| License Number: | 12642 |
| Business Practice Address: | 707 Sw Gaines St Portland, OR - 972392901 |
| Business Phone Number: | 8004523563 |
| Business Fax Number: | |
| Mailing Address: | 3181 Sw Sam Jackson Park Rd, PORTLAND |
| State: | OR |
| Postal Code: | 972393011 |
| Phone Number: | 5034949045 |
| Fax Number: | 5034185203 |
| NPI Enumeration Date: | 08/03/2006 |
| NPI Last Update Date: | 07/08/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 12642 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |