| Doctor Name: | MANZA BLAINE |
| NPI Number: | 1770732539 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | S2770 |
| Business Practice Address: | 310 Autumn Ridge Dr Kosciusko, MS - 390903242 |
| Business Phone Number: | 6012504815 |
| Business Fax Number: | |
| Mailing Address: | 202 Galloway Dr, KOSCIUSKO |
| State: | MS |
| Postal Code: | 390903920 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/16/2008 |
| NPI Last Update Date: | 09/30/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | S2770 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |