Individual
MRS. MARY THERESA MANZANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
1604 COLUMBINE VILLAGE DR, WOODLAND PARK, CO 80863-8339
(737) 787-7367
Mailing address
PO BOX 242, LAKESIDE, OR 97449-0242
(928) 243-3245
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
016183
OR
235Z00000X
Speech-Language Pathologist
Primary
13710
CA
235Z00000X
Speech-Language Pathologist
5589
CO
235Z00000X
Speech-Language Pathologist
LL61410586
WA
235Z00000X
Speech-Language Pathologist
SLP4815
AZ
Other
Enumeration date
01/24/2007
Last updated
10/03/2023
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