MEDICARE: ANNA AMELIA MANLEY LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	21031875	SD

General Provider Information

NPI Number	:	1043102411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA AMELIA MANLEY LAC

Provider Business Mailing Address
First Line	:	906 W 5TH ST
Second Line	:
City	:	CANTON
State	:	SD
Zip	:	57013-1532
Country	:	US
Telephone Number	:	605-251-4554
Fax Number	:

Provider Business Practice Location Address
First Line	:	906 W 5TH ST
Second Line	:
City	:	CANTON
State	:	SD
Zip	:	57013-1532
Country	:	US
Telephone Number	:	605-251-4554
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2025
Last Update Date	:	07/18/2025

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Directions to “ ANNA AMELIA MANLEY LAC” Practice Location

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