Provider Demographics
NPI:1376198606
Name:MANNING, AMANDA (SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MANNING
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1051 JOHNNIE DODDS BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3100
Mailing Address - Country:US
Mailing Address - Phone:843-708-9138
Mailing Address - Fax:843-480-9844
Practice Address - Street 1:1051 JOHNNIE DODDS BLVD STE G
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3100
Practice Address - Country:US
Practice Address - Phone:843-654-9694
Practice Address - Fax:843-480-9844
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6965235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6965OtherSTATE LICENSE