Provider Information for 1912401456
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JANICE LORRAINE MANTELL MA
Sex: Female
NPI: 1912401456
Last Updated: 2018-03-20
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1912401456 | ||||||||
| Enumeration Date | 2018-03-20 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4455 NE HIGHWAY 20 CORVALLIS, OR 97330-9695 United States Phone: 541-758-5900 | Fax: | ||||||||
| Primary Practice Address | 4455 NE HIGHWAY 20 CORVALLIS, OR 97330-9695 United States Phone: 541-758-5900 | Fax: | ||||||||
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