=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114381852
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANN MARIE MANNING CSW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2016
-----------------------------------------------------
Last Update Date | 01/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2021 W COLORADO AVE
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80904-3840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-393-5673
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 713
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80901-0713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-393-5673
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPIETER
-----------------------------------------------------
Name | MS. ANN-MARIE MANNING
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 719-393-5673
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 09924307
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------