Provider Demographics
NPI:1174741839
Name:STANLEY, AMY (SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10074 TATE LANE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72833
Mailing Address - Country:US
Mailing Address - Phone:479-495-6326
Mailing Address - Fax:479-495-3336
Practice Address - Street 1:719 N DETROIT
Practice Address - Street 2:HIGHWAY 10 AT DETROIT
Practice Address - City:DANVILLE
Practice Address - State:AR
Practice Address - Zip Code:72833
Practice Address - Country:US
Practice Address - Phone:479-495-6326
Practice Address - Fax:479-495-3336
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP1694235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR12037270OtherAMERICAN ST, LANG, ASSOC
AR5U922OtherBLUE CROSS ID NUMBER
ARSP1694OtherSTATE LICENSE NUMBER