Provider Demographics
NPI:1912002601
Name:MANNING, JILLIAN FAYE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:FAYE
Last Name:MANNING
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:JILLIAN
Other - Middle Name:FAYE
Other - Last Name:HERMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:300 ALCOA DR
Mailing Address - Street 2:
Mailing Address - City:PORT LAVACA
Mailing Address - State:TX
Mailing Address - Zip Code:77979-3604
Mailing Address - Country:US
Mailing Address - Phone:361-552-9404
Mailing Address - Fax:
Practice Address - Street 1:300 ALCOA DR
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-3604
Practice Address - Country:US
Practice Address - Phone:361-552-9404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24944235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist