Provider Demographics
NPI:1730317959
Name:MANNING, CHANTALE EVA (SLP)
Entity Type:Individual
Prefix:
First Name:CHANTALE
Middle Name:EVA
Last Name:MANNING
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CHANTALE
Other - Middle Name:EVA
Other - Last Name:WINSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1259 CHINON PT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-7058
Mailing Address - Country:US
Mailing Address - Phone:501-328-3733
Mailing Address - Fax:
Practice Address - Street 1:2915 S HAZEL ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5008
Practice Address - Country:US
Practice Address - Phone:870-535-0010
Practice Address - Fax:870-535-1116
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2013-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8101235Z00000X
GASLP008185235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist