Provider Demographics
NPI:1902915416
Name:MANN, DAVID ALAN (MS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALAN
Last Name:MANN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 BURLEW BLVD
Mailing Address - Street 2:APT 434
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1700
Mailing Address - Country:US
Mailing Address - Phone:270-683-2458
Mailing Address - Fax:
Practice Address - Street 1:2785 VEACH RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6250
Practice Address - Country:US
Practice Address - Phone:270-685-1755
Practice Address - Fax:270-685-1759
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0036231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
163667800OtherUSDOL
K008903OtherTRICARE
KY000000043028OtherANTHEM BC/BS
KY70000369Medicaid
KY3010201Medicare ID - Type Unspecified