Provider Demographics
NPI:1609586965
Name:MANNING, DEIRDRE ANNE (LSW)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:ANNE
Last Name:MANNING
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:DEIRDRE
Other - Middle Name:A
Other - Last Name:OSTRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1627 HENTHORNE DR STE C
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1370
Mailing Address - Country:US
Mailing Address - Phone:419-491-0420
Mailing Address - Fax:567-698-7875
Practice Address - Street 1:1627 HENTHORNE DR STE C
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1370
Practice Address - Country:US
Practice Address - Phone:419-491-0420
Practice Address - Fax:567-698-7875
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2107181104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker