Provider Demographics
NPI:1760779193
Name:MANNING, LINDSAY KAYE (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:KAYE
Last Name:MANNING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LINDAY
Other - Middle Name:KAYE
Other - Last Name:HEWITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:348 E 4500 S
Mailing Address - Street 2:STE 360
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3920
Mailing Address - Country:US
Mailing Address - Phone:385-272-7292
Mailing Address - Fax:866-855-3582
Practice Address - Street 1:348 E 4500 S
Practice Address - Street 2:STE 360
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:385-272-7292
Practice Address - Fax:866-855-3582
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT805320835011041C0700X
1041C0700X
UT8053208-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1760779193Medicaid