Individual
MRS. MARY S MANAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCCA
Contact information
Practice address
4408 MACCORKLE AVE SE, CHARLESTON, WV 25304-2506
(304) 357-9059
(304) 357-4412
Mailing address
4408 MACCORKLE AVE SE, CHARLESTON, WV 25304-2506
(304) 357-9059
(304) 357-4412
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
A0198
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3403015000
—
WV
01
—
A0198
STATE LICENSE
WV
Enumeration date
10/05/2006
Last updated
12/14/2015
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