Provider Demographics
NPI:1104605237
Name:MANNING, REAGAN G (AUD)
Entity type:Individual
Prefix:DR
First Name:REAGAN
Middle Name:G
Last Name:MANNING
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:REAGAN
Other - Middle Name:MANNING
Other - Last Name:RUSKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:371 N STONECROP CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-1585
Mailing Address - Country:US
Mailing Address - Phone:919-455-4622
Mailing Address - Fax:
Practice Address - Street 1:LAPOINTE CLINIC
Practice Address - Street 2:5979 DESERT STORM AVE, KY
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:42223
Practice Address - Country:US
Practice Address - Phone:919-455-4622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023038577231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist