Provider Demographics
NPI:1013994631
Name:MANWARING, JEFFREY A (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:MANWARING
Suffix:
Gender:M
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 E FOREMASTER DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4488
Mailing Address - Country:US
Mailing Address - Phone:435-688-2456
Mailing Address - Fax:435-986-4096
Practice Address - Street 1:1490 EAST FOREMASTER DRIVE
Practice Address - Street 2:SUITE 140
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4488
Practice Address - Country:US
Practice Address - Phone:435-688-2456
Practice Address - Fax:435-986-4096
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT263454-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057179Medicaid
UT000057179Medicaid