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NPI Code Detail

MEDICARE: CALLIE MANASCO

MEDICARE:   CALLIE  MANASCO
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
1106S00000XBehavior Technician
2235Z00000XSpeech-Language Pathologist7101009373MI

General Provider Information

NPI Number : 1831772060
Entity Type Code : Individual
Provider Name (Legal Business Name) : CALLIE MANASCO
Provider Business Mailing Address
First Line : 44670 ANN ARBOR RD W
Second Line :
City : PLYMOUTH
State : MI
Zip : 48170-3962
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 390 ENTERPRISE CT STE 100
Second Line :
City : BLOOMFIELD HILLS
State : MI
Zip : 48302-0320
Country : US
Telephone Number : 248-214-7755
Fax Number : 248-940-2739
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2021
Last Update Date : 02/04/2026

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Directions to “ CALLIE MANASCO ” Practice Location

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