Provider Demographics
NPI:1710623137
Name:MANESS, ANSLEY NOEL (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANSLEY
Middle Name:NOEL
Last Name:MANESS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 GILBERT ST SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2102
Mailing Address - Country:US
Mailing Address - Phone:865-209-1894
Mailing Address - Fax:
Practice Address - Street 1:2660 GILBERT ST SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-2102
Practice Address - Country:US
Practice Address - Phone:865-209-1894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012050235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist