Provider Demographics
NPI:1841518354
Name:MANNING, TANYA S (MED CCC/SLP)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:S
Last Name:MANNING
Suffix:
Gender:F
Credentials:MED CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 REBIE RD
Mailing Address - Street 2:
Mailing Address - City:COCHRAN
Mailing Address - State:GA
Mailing Address - Zip Code:31014-2632
Mailing Address - Country:US
Mailing Address - Phone:478-358-9447
Mailing Address - Fax:
Practice Address - Street 1:385 REBIE RD
Practice Address - Street 2:
Practice Address - City:COCHRAN
Practice Address - State:GA
Practice Address - Zip Code:31014-2632
Practice Address - Country:US
Practice Address - Phone:478-358-9447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003857235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist