MEDICARE: KATHERINE MANRIQUE M.S., 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	SA17564	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770127227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE MANRIQUE M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	510 HICKORYNUT AVE
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-2019
Country	:	US
Telephone Number	:	727-804-4836
Fax Number	:

Provider Business Practice Location Address
First Line	:	2595 TAMPA RD STE Q
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3132
Country	:	US
Telephone Number	:	727-431-0286
Fax Number	:

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

Provider Enumeration Date	:	10/28/2019
Last Update Date	:	10/28/2019

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Directions to “ KATHERINE MANRIQUE M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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