Provider Demographics
NPI:1669596391
Name:HERNANDEZ MCMANUS, MARIE ISABEL (CCC-SLP/BSLP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ISABEL
Last Name:HERNANDEZ MCMANUS
Suffix:
Gender:F
Credentials:CCC-SLP/BSLP
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:ISABEL
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP/BSLP
Mailing Address - Street 1:7930 ENGLISH OAK CIR
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-2537
Mailing Address - Country:US
Mailing Address - Phone:469-231-4746
Mailing Address - Fax:
Practice Address - Street 1:7930 ENGLISH OAK CIR
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-2537
Practice Address - Country:US
Practice Address - Phone:469-231-4746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21006235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist