Provider Demographics
NPI:1740953132
Name:MANUK, JENNIFER K
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:K
Last Name:MANUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12741 DARBY BROOK CT STE 102S
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2406
Mailing Address - Country:US
Mailing Address - Phone:888-467-8241
Mailing Address - Fax:
Practice Address - Street 1:12741 DARBY BROOK CT STE 102S
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2406
Practice Address - Country:US
Practice Address - Phone:888-467-8241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician