Provider Demographics
NPI:1245509942
Name:MANIS, LINDSAY NICOLE (MACCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:NICOLE
Last Name:MANIS
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3197 SWEET CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8579
Mailing Address - Country:US
Mailing Address - Phone:502-821-5580
Mailing Address - Fax:
Practice Address - Street 1:3197 SWEET CLOVER LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-8579
Practice Address - Country:US
Practice Address - Phone:502-821-5580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3980235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist