Healthcare Provider Details

I. General information

NPI: 1912198383
Provider Name (Legal Business Name): SUSAN S. MANNING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2239 WALKER AVENUE
BURLINGTON NC
27215-4520
US

IV. Provider business mailing address

2239 WALKER AVENUE
BURLINGTON NC
27215-4520
US

V. Phone/Fax

Practice location:
  • Phone: 336-213-4001
  • Fax:
Mailing address:
  • Phone: 336-213-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberNC LICENSE 1778
License Number StateNC

VIII. Authorized Official

Name: MS. SUSAN S MANNING
Title or Position: SPEECH/LANGUAGE PATHOLOGIST/OWNER
Credential: CCC/SLP
Phone: 336-213-4001