Provider Demographics
NPI:1508185547
Name:MANALANSAN, TERESE JIMENEZ (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:TERESE
Middle Name:JIMENEZ
Last Name:MANALANSAN
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ALBOURNE ST
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3353
Mailing Address - Country:US
Mailing Address - Phone:732-623-9619
Mailing Address - Fax:
Practice Address - Street 1:4 BRIDGE ST BLDG C
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840
Practice Address - Country:US
Practice Address - Phone:732-623-9619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00472200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist