Provider Demographics
NPI:1093379240
Name:MANN, KAY
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:MANN
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:PO BOX 4203
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-0203
Mailing Address - Country:US
Mailing Address - Phone:330-259-5469
Mailing Address - Fax:
Practice Address - Street 1:487 N FOUR MILE RUN RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-1502
Practice Address - Country:US
Practice Address - Phone:330-259-5469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No253Z00000XAgenciesIn Home Supportive Care