Destiny Miller Mangan, M.S. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP012443 Issued in GA

Practice address

165 Ridgecrest Cir
Clayton, GA 30525-4110

Phone

(678) 357-5849

NPI assigned

Jan 20, 2022

Last updated

Jan 1, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fundamental Therapy Services, LLC

  • Occupational Therapist
  • Clayton, GA
  • NPI 1780110155
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704067200000",
    "number": "1245982289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 RIDGECREST CIR",
            "city": "CLAYTON",
            "state": "GA",
            "postal_code": "305254110",
            "telephone_number": "678-357-5849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 RIDGECREST CIR",
            "city": "CLAYTON",
            "state": "GA",
            "postal_code": "305254110",
            "telephone_number": "678-357-5849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGAN",
        "first_name": "DESTINY",
        "middle_name": "MILLER",
        "name_prefix": "Mrs.",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-20",
        "last_updated": "2024-01-01",
        "certification_date": "2024-01-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "PCET003509",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP012443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Life Point Medical, LLC
• Amy Lovelace, RPH
• Sherri Stephens Lovett, RPH
• Carl W. Lynn, D.C.
• John Fitzgerald Mally Jr.
• Jennifer Marcellino, PA-C
• Barbara H Marshall, LPC
• Kimberly J Martin, MD
• Shannon Michelle Mattingly, OTR/L
• William Franklin McDaniel, PH.D.

• Speech-Language Pathologist in Clayton, GA
• Providers in Clayton, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.