Provider Demographics
NPI:1245830645
Name:MANLEY, REBECCA ANGELA THERESE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANGELA THERESE
Last Name:MANLEY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 PENAMINT CT
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-9598
Mailing Address - Country:US
Mailing Address - Phone:218-348-9169
Mailing Address - Fax:
Practice Address - Street 1:940 PENAMINT CT
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-9598
Practice Address - Country:US
Practice Address - Phone:218-348-9169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist