Provider Demographics
NPI:1407336696
Name:MANLEY, JENNIFER JENNINGS (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JENNINGS
Last Name:MANLEY
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC/SLP
Mailing Address - Street 1:834 SWEET IRON RD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4934
Mailing Address - Country:US
Mailing Address - Phone:972-839-5649
Mailing Address - Fax:
Practice Address - Street 1:10700 ROLATER RD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-2972
Practice Address - Country:US
Practice Address - Phone:972-712-8652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19593235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX19593OtherTEXAS LICENSE