Organization
FOUNDATIONS FOR LIFE CLINIC LLC
Active
Other names
MANZANO SPEECH THERAPY
Organization subpart
No
Provider details
NPI number
Authorized official
MARY T MANZANO (MEMBER)
(737) 787-7367
Entity
Organization
Contact information
Practice address
70909 DEVORE ARM RD, LAKESIDE, OR 97449-8502
(737) 787-7367
Mailing address
PO BOX 242, LAKESIDE, OR 97449-0242
(737) 787-7367
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
09/14/2022
Last updated
09/14/2022
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