Provider Demographics
NPI:1295368025
Name:STANLEY, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:STANLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8769 W NORTHVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-6938
Mailing Address - Country:US
Mailing Address - Phone:623-229-0499
Mailing Address - Fax:
Practice Address - Street 1:8769 WEST NORTHVIEW AVENUE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305
Practice Address - Country:US
Practice Address - Phone:623-203-4109
Practice Address - Fax:623-547-6473
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA108852355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty