Provider Demographics
NPI:1194319327
Name:MANNS, TAQUASHA SHANTRELL (LSW)
Entity type:Individual
Prefix:MS
First Name:TAQUASHA
Middle Name:SHANTRELL
Last Name:MANNS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MISS
Other - First Name:TAQUASHA
Other - Middle Name:SHANTRELL
Other - Last Name:KYLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:918 WARING DR W
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-2865
Mailing Address - Country:US
Mailing Address - Phone:317-845-6022
Mailing Address - Fax:
Practice Address - Street 1:1311 N ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3286
Practice Address - Country:US
Practice Address - Phone:317-222-5064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99099756A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker