Provider Demographics
NPI:1942623780
Name:POHLMAN, MANDY LEE (MS-CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:LEE
Last Name:POHLMAN
Suffix:
Gender:F
Credentials:MS-CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:IL
Mailing Address - Zip Code:62016-1513
Mailing Address - Country:US
Mailing Address - Phone:217-248-7619
Mailing Address - Fax:618-498-9025
Practice Address - Street 1:944 4TH ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:IL
Practice Address - Zip Code:62016-1513
Practice Address - Country:US
Practice Address - Phone:217-248-7619
Practice Address - Fax:618-498-9025
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006734235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist