Provider Demographics
NPI:1841235892
Name:MANBY, JON K (LMSW, ACSW)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:K
Last Name:MANBY
Suffix:
Gender:M
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 W MANCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3016
Mailing Address - Country:US
Mailing Address - Phone:269-660-3900
Mailing Address - Fax:269-660-3899
Practice Address - Street 1:5400 HOLIDAY TER
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2161
Practice Address - Country:US
Practice Address - Phone:269-372-4500
Practice Address - Fax:269-372-7230
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010205871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical