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General NPI Number Information
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NPI Number | 1730097767
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Entity Type | Individual
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Provider Name | JENNIFER LYNN MANFRED
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Gender | Female
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Dates
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Enumeration Date | 08/31/2026
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Last Update Date | 08/31/2026
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Provider Practice Location Address
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Address Line | 12 THUNDERBIRD DR
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City | SHERIDAN
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State | WY
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Zip | 82801-8936
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Country | US
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Telephone | 216-337-9888
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Fax |
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Provider Business Mailing Address
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Address Line | 7939 GATES MILLS ESTATE DR
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City | GATES MILLS
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State | OH
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Zip | 44040-9303
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Country | US
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Telephone | 216-337-9888
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP-1507
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License Number State | WY
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