Provider Demographics
NPI:1477070878
Name:MANLEY, ANITA O
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:O
Last Name:MANLEY
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 1:3256 LIV MOOR DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-3548
Mailing Address - Country:US
Mailing Address - Phone:614-537-5372
Mailing Address - Fax:
Practice Address - Street 1:1545 HUY ROAD
Practice Address - Street 2:CCS SPEECH-LANGUAGE SVS.
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-3531
Practice Address - Country:US
Practice Address - Phone:614-365-5230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP2250235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist