Provider Demographics
NPI:1336459627
Name:MANNING, SUSIANE
Entity Type:Individual
Prefix:
First Name:SUSIANE
Middle Name:
Last Name:MANNING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSIANE
Other - Middle Name:
Other - Last Name:SIULUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2328 HIDDEN VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-5646
Mailing Address - Country:US
Mailing Address - Phone:801-209-6985
Mailing Address - Fax:
Practice Address - Street 1:2328 HIDDEN VALLEY CIR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84092-5646
Practice Address - Country:US
Practice Address - Phone:801-209-6985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6081077-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical