MEDICARE: MR. MCKINLEY HUNTER MANASCO CCC-SLP

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	2447	AL

General Provider Information

NPI Number	:	1659420362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MCKINLEY HUNTER MANASCO CCC-SLP

Provider Business Mailing Address
First Line	:	3024 LINDHOLM DR E
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36693-3540
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 HAND AVE
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-4149
Country	:	US
Telephone Number	:	251-937-2823
Fax Number	:

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. MCKINLEY HUNTER MANASCO CCC-SLP” Practice Location

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