Provider Demographics
NPI:1578334744
Name:MANU, ANJALI
Entity Type:Individual
Prefix:MRS
First Name:ANJALI
Middle Name:
Last Name:MANU
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 1:6842 SERAPHINA DR
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-8171
Mailing Address - Country:US
Mailing Address - Phone:510-432-8689
Mailing Address - Fax:
Practice Address - Street 1:632 W 11TH ST STE 119
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3860
Practice Address - Country:US
Practice Address - Phone:209-237-2484
Practice Address - Fax:209-237-2485
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18847235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist