Healthcare Provider Details

I. General information

NPI: 1497985873
Provider Name (Legal Business Name): KERRI BETH CARSON MANNION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 C ST
MINOT AFB ND
58704-1202
US

IV. Provider business mailing address

106 GRAMERCY CT APT 1
MINOT AFB ND
58704-1168
US

V. Phone/Fax

Practice location:
  • Phone: 701-727-3320
  • Fax:
Mailing address:
  • Phone: 520-664-8529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3032
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: