Provider Demographics
NPI:1922611987
Name:MANNAN, SAMEEN
Entity Type:Individual
Prefix:
First Name:SAMEEN
Middle Name:
Last Name:MANNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720 E GREEN LAKE WAY N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-5439
Mailing Address - Country:US
Mailing Address - Phone:206-525-9666
Mailing Address - Fax:
Practice Address - Street 1:5725 NW 186TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33015-6019
Practice Address - Country:US
Practice Address - Phone:305-625-9857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61107451235Z00000X
FLSA19770235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist