Provider Demographics
NPI:1093964751
Name:MANNING, JAMI MELINA (MSW, CACI)
Entity Type:Individual
Prefix:MRS
First Name:JAMI
Middle Name:MELINA
Last Name:MANNING
Suffix:
Gender:F
Credentials:MSW, CACI
Other - Prefix:MISS
Other - First Name:JAMI
Other - Middle Name:MELINA
Other - Last Name:OLIVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:3122 HERRICK PL
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3838
Mailing Address - Country:US
Mailing Address - Phone:719-583-0578
Mailing Address - Fax:
Practice Address - Street 1:1304 CHINOOK LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1851
Practice Address - Country:US
Practice Address - Phone:719-545-2746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6321101YA0400X
COCSW.099261351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)