Provider Demographics
NPI:1366840530
Name:MANLEY, GENIA DREHER (SLP)
Entity Type:Individual
Prefix:MRS
First Name:GENIA
Middle Name:DREHER
Last Name:MANLEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8212 BEARDSLEY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7167
Mailing Address - Country:US
Mailing Address - Phone:704-403-0200
Mailing Address - Fax:704-403-0271
Practice Address - Street 1:8212 BEARDSLEY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-7167
Practice Address - Country:US
Practice Address - Phone:704-403-0200
Practice Address - Fax:704-403-0271
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7540235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist