Provider Demographics
NPI:1912382615
Name:JENNIFER A. MANNING
Entity Type:Organization
Organization Name:JENNIFER A. MANNING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:218-416-2268
Mailing Address - Street 1:419 3RD ST E STE B
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-2102
Mailing Address - Country:US
Mailing Address - Phone:218-416-2268
Mailing Address - Fax:
Practice Address - Street 1:419 3RD ST E STE B
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-2102
Practice Address - Country:US
Practice Address - Phone:218-416-2268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN162941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty