Provider Demographics
NPI:1841065513
Name:MANISH, AGNES MARIA
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:MARIA
Last Name:MANISH
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 1:9042 MAJOR AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2534
Mailing Address - Country:US
Mailing Address - Phone:224-436-5086
Mailing Address - Fax:
Practice Address - Street 1:1318 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-3022
Practice Address - Country:US
Practice Address - Phone:847-595-4808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician