Provider Demographics
NPI:1144485327
Name:MANGUM-JONES, LACEY (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:
Last Name:MANGUM-JONES
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MRS
Other - First Name:LACEY
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:10712 BALUSTRADE CT
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-6946
Mailing Address - Country:US
Mailing Address - Phone:602-363-1863
Mailing Address - Fax:
Practice Address - Street 1:10712 BALUSTRADE CT
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-6946
Practice Address - Country:US
Practice Address - Phone:602-363-1863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11596235Z00000X
CASP22565235Z00000X
FLTPSA179235Z00000X
TN7684235Z00000X
AZTSLP5915235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCPE-3X71K8DY6Medicaid