MEDICARE: MRS. JOANNE MANNING LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801088871	MI

General Provider Information

NPI Number	:	1225269392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOANNE MANNING LMSW

Provider Business Mailing Address
First Line	:	16559 LOHR RD
Second Line	:
City	:	BELLEVILLE
State	:	MI
Zip	:	48111-2569
Country	:	US
Telephone Number	:	734-697-8559
Fax Number	:	734-697-8559

Provider Business Practice Location Address
First Line	:	16559 LOHR RD
Second Line	:
City	:	VAN BUREN TWP
State	:	MI
Zip	:	48111-2569
Country	:	US
Telephone Number	:	734-697-8559
Fax Number	:	734-697-8559

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2009
Last Update Date	:	08/06/2009

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