MEDICARE: CHRISTIAN ELAINE MANTON

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	235Z00000X	Speech-Language Pathologist	TSLP8381	AZ

General Provider Information

NPI Number	:	1073945978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN ELAINE MANTON

Provider Business Mailing Address
First Line	:	2205 N 16TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85007-1408
Country	:	US
Telephone Number	:	480-720-0921
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 E BROWN RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-5315
Country	:	US
Telephone Number	:	480-472-6900
Fax Number	:

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

Provider Enumeration Date	:	08/01/2013
Last Update Date	:	08/22/2016

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Directions to “ CHRISTIAN ELAINE MANTON ” Practice Location

Language	Start Address	Practice Location

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