Provider Demographics
NPI:1487668117
Name:MANCHESTER, LINDA M (MSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:MANCHESTER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2698 LANAI CT
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8615
Mailing Address - Country:US
Mailing Address - Phone:970-242-3505
Mailing Address - Fax:970-242-1091
Practice Address - Street 1:2698 LANAI CT
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8615
Practice Address - Country:US
Practice Address - Phone:970-242-3505
Practice Address - Fax:970-242-1091
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical