Provider Demographics
NPI:1124491527
Name:MANZI, LILLY (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LILLY
Middle Name:
Last Name:MANZI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13900 HULL STREET RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2004
Mailing Address - Country:US
Mailing Address - Phone:804-639-8788
Mailing Address - Fax:
Practice Address - Street 1:1015 OAKHURST DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-2049
Practice Address - Country:US
Practice Address - Phone:304-345-8101
Practice Address - Fax:304-345-7386
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1672235Z00000X
VA2202008297235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist