Provider Demographics
NPI:1073867008
Name:STANBERY, LYDIA
Entity Type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:
Last Name:STANBERY
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 1:1027 ROE ST
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-4009
Mailing Address - Country:US
Mailing Address - Phone:253-588-2336
Mailing Address - Fax:
Practice Address - Street 1:1027 ROE ST
Practice Address - Street 2:
Practice Address - City:STEILACOOM
Practice Address - State:WA
Practice Address - Zip Code:98388-4009
Practice Address - Country:US
Practice Address - Phone:253-588-2336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health