Provider Demographics
NPI:1184014243
Name:STANLEY, EMILY (MA CCC-SLP/IBCLC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MA CCC-SLP/IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 DOE CT
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8077
Mailing Address - Country:US
Mailing Address - Phone:765-748-4452
Mailing Address - Fax:
Practice Address - Street 1:102 DOE CT
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8077
Practice Address - Country:US
Practice Address - Phone:765-748-4452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY140375235Z00000X
KYL-313176174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist