Provider Demographics
NPI:1760647135
Name:MANTHIE, MARTHA E (MA)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:E
Last Name:MANTHIE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE VETERANS DRIVE
Mailing Address - Street 2:127A MINNEAPOLIS VA MEDICAL CENTER
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2309
Mailing Address - Country:US
Mailing Address - Phone:612-467-3591
Mailing Address - Fax:612-727-5693
Practice Address - Street 1:ONE VETERANS DRIVE
Practice Address - Street 2:127A MINNEAPOLIS VA MEDICAL CENTER
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-3591
Practice Address - Fax:612-727-5693
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5526235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist