Provider Demographics
NPI:1528694650
Name:MCMANUS, KELSEY JAYE
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:JAYE
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1325
Mailing Address - Country:US
Mailing Address - Phone:516-707-2438
Mailing Address - Fax:
Practice Address - Street 1:11 LINDEN ST
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1325
Practice Address - Country:US
Practice Address - Phone:516-707-2438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist