Provider Demographics
NPI:1720449523
Name:MANN, MICHELLE FAITH (MS)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:FAITH
Last Name:MANN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-2645
Mailing Address - Country:US
Mailing Address - Phone:727-871-1853
Mailing Address - Fax:
Practice Address - Street 1:1171 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-2645
Practice Address - Country:US
Practice Address - Phone:727-871-1853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator