Provider Demographics
NPI:1083628598
Name:MANN, TONI DAVIS (AUD CCC A)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:DAVIS
Last Name:MANN
Suffix:
Gender:F
Credentials:AUD CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 82ND STREET
Mailing Address - Street 2:SUITE 8
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3219
Mailing Address - Country:US
Mailing Address - Phone:806-798-3600
Mailing Address - Fax:806-798-3601
Practice Address - Street 1:4505 82ND STREET
Practice Address - Street 2:SUITE 8
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3219
Practice Address - Country:US
Practice Address - Phone:806-798-3600
Practice Address - Fax:806-798-3601
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50735231H00000X
TX3398237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102313100OtherFIRST CARE LIFE & HEALTH
TX022447901Medicaid
TX80247AOtherBCBS
TX022447901Medicaid
TX102313100OtherFIRST CARE LIFE & HEALTH