Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 5340 | OH |
Y | 103TC0700X | Clinical Psychologist | 5340 | OH |
NPI | 1003816091 |
---|---|
Provider Name | Dr. Leanna Elaine Manuel |
First Address | Beavercreek, OH 45432-2851 |
Second Address | Beavercreek, OH 45432-2851 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2005 |
Last Update Date | 10/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2261421 | (05) | OH |
311588267 | TRICARE (01) | OH |