Provider Demographics
NPI:1710164132
Name:MCMANUS, SUSIE A (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUSIE
Middle Name:A
Last Name:MCMANUS
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 1:2909 N SHERIDAN RD
Mailing Address - Street 2:#1004
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5978
Mailing Address - Country:US
Mailing Address - Phone:559-940-3885
Mailing Address - Fax:
Practice Address - Street 1:1308 WAUKEGAN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-3070
Practice Address - Country:US
Practice Address - Phone:877-486-4140
Practice Address - Fax:847-486-4145
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-009034235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist