Provider Demographics
NPI:1043737620
Name:MANNING, ERIN ELAINE
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:ELAINE
Last Name:MANNING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 CONTRA COSTA AVE
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-7226
Mailing Address - Country:US
Mailing Address - Phone:253-229-4707
Mailing Address - Fax:
Practice Address - Street 1:3560 BRIDGEPORT WAY W STE 2C
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4446
Practice Address - Country:US
Practice Address - Phone:253-460-7248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG.60976878106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist