=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750285680
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OLIVIA MANN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2026
-----------------------------------------------------
Last Update Date | 10/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18853 US HIGHWAY 12 STE 3
-----------------------------------------------------
City | NEW BUFFALO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49117-8100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-235-9547
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15872 CENTER AVE
-----------------------------------------------------
City | UNION PIER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49129-9417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 7101010173
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------