Individual
LAURA GRACE MANIMTIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4176 CHITTENDEN CIR, RIVERSIDE, CA 92509-6867
(831) 676-5562
Mailing address
4176 CHITTENDEN CIR, RIVERSIDE, CA 92509-6867
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
5060
CA
Other
Enumeration date
05/07/2019
Last updated
05/07/2019
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