Provider Demographics
NPI:1104166446
Name:MANKER, JACQUELINE M
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:M
Last Name:MANKER
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 1:101 NORTH BEND DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-2130
Mailing Address - Country:US
Mailing Address - Phone:618-292-1126
Mailing Address - Fax:618-589-9001
Practice Address - Street 1:101 N BEND DR
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2130
Practice Address - Country:US
Practice Address - Phone:618-292-1126
Practice Address - Fax:618-589-9001
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-24
Last Update Date:2013-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter