MEDICARE: HEATHER LYNN MANLY SLP/CCC M.S.

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	235Z00000X	Speech-Language Pathologist	111273	TX

General Provider Information

NPI Number	:	1871136473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER LYNN MANLY SLP/CCC M.S.

Provider Business Mailing Address
First Line	:	13077 VEGA CT
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77318-5088
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 N DANVILLE ST
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77378-3490
Country	:	US
Telephone Number	:	936-856-4312
Fax Number	:

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

Provider Enumeration Date	:	10/26/2019
Last Update Date	:	10/26/2019

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Directions to “ HEATHER LYNN MANLY SLP/CCC M.S.” Practice Location

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