Provider Demographics
NPI:1275926107
Name:SHELLEY A MANNING LTD
Entity Type:Organization
Organization Name:SHELLEY A MANNING LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:815-474-2146
Mailing Address - Street 1:414 W HUNTER LN
Mailing Address - Street 2:
Mailing Address - City:MINOOKA
Mailing Address - State:IL
Mailing Address - Zip Code:60447-4519
Mailing Address - Country:US
Mailing Address - Phone:815-474-2146
Mailing Address - Fax:815-290-5133
Practice Address - Street 1:414 W HUNTER LN
Practice Address - Street 2:
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447-4519
Practice Address - Country:US
Practice Address - Phone:815-474-2146
Practice Address - Fax:815-290-5133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006630235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty