Provider Demographics
NPI:1417115296
Name:MANZA, MONICA C
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:C
Last Name:MANZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 N OLSON HILL CT
Mailing Address - Street 2:
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-8850
Mailing Address - Country:US
Mailing Address - Phone:509-299-5293
Mailing Address - Fax:509-299-5293
Practice Address - Street 1:1801 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1819
Practice Address - Country:US
Practice Address - Phone:509-202-5987
Practice Address - Fax:509-299-5293
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00004128235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist