Provider Demographics
NPI:1588438311
Name:MANNING, JOEY ELAINE
Entity type:Individual
Prefix:
First Name:JOEY
Middle Name:ELAINE
Last Name:MANNING
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 1:1920 20TH AVE NW APT B
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-7928
Mailing Address - Country:US
Mailing Address - Phone:507-513-3442
Mailing Address - Fax:
Practice Address - Street 1:1920 20TH AVE NW APT B
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-7928
Practice Address - Country:US
Practice Address - Phone:507-513-3442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician