Basic Information
| Provider Information | |||||||||
| NPI: | 1902527138 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANNERS | ||||||||
| FirstName: | MARAH | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 72 S 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | BEECH GROVE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461071827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174449051 | ||||||||
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| Practice Location | |||||||||
| Address1: | 374 MERIDIAN PARKE LN | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461429406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178895437 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2022 | ||||||||
| LastUpdateDate: | 09/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 46003981A | IN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.