Provider Demographics
NPI:1780833871
Name:MANASCO, DEBRA KAY (MSP, CC-SLP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAY
Last Name:MANASCO
Suffix:
Gender:F
Credentials:MSP, CC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 BURKE AVE
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:AR
Mailing Address - Zip Code:72360-1701
Mailing Address - Country:US
Mailing Address - Phone:870-295-6166
Mailing Address - Fax:
Practice Address - Street 1:207 BALFOUR RD
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-1701
Practice Address - Country:US
Practice Address - Phone:870-735-8592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP632235Z00000X
ARASHA01103682235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist