Provider Demographics
NPI:1912198383
Name:SUSAN S. MANNING
Entity Type:Organization
Organization Name:SUSAN S. MANNING
Other - Org Name:DEVELOPMENTAL THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:CCC/SLP
Authorized Official - Phone:336-213-4001
Mailing Address - Street 1:2239 WALKER AVENUE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-4520
Mailing Address - Country:US
Mailing Address - Phone:336-213-4001
Mailing Address - Fax:
Practice Address - Street 1:2239 WALKER AVENUE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-4520
Practice Address - Country:US
Practice Address - Phone:336-213-4001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC LICENSE 1778235Z00000X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13295OtherBLUECROSSBLUESHIELD/NC
NC7210809Medicaid
NC7411651Medicaid