Provider Demographics
NPI:1750535803
Name:MANNING, BETHANY LYNN (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:LYNN
Last Name:MANNING
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PENROSE DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-1218
Mailing Address - Country:US
Mailing Address - Phone:912-844-4583
Mailing Address - Fax:
Practice Address - Street 1:111 PENROSE DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-1218
Practice Address - Country:US
Practice Address - Phone:912-844-4583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006524235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA12072367OtherAMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION
GASLP006524OtherSTATE OF GEORGIA