Basic Information
| Provider Information | |||||||||
| NPI: | 1154721082 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANN | ||||||||
| FirstName: | ADRIENNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.A. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7591 TYLERS PLACE BLVD | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450696308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137556600 | ||||||||
| FaxNumber: | 5137553762 | ||||||||
| Practice Location | |||||||||
| Address1: | 3817 COLONEL GLENN HWY | ||||||||
| Address2: | |||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453242268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374279200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2014 | ||||||||
| LastUpdateDate: | 07/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | COND.2014299-SP | OH | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SP23223 | CA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SP11668 | OH | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 0406425 | 05 | OH | MEDICAID | AB7360731 | 01 | OH | MEDICARE PIN | OTHER |