Provider Demographics
NPI:1336324177
Name:STANFIELD, KATY REBECCA (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATY
Middle Name:REBECCA
Last Name:STANFIELD
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9230 E STATE ROAD 32
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-9750
Mailing Address - Country:US
Mailing Address - Phone:317-727-6795
Mailing Address - Fax:317-769-7439
Practice Address - Street 1:9230 E STATE ROAD 32
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-9750
Practice Address - Country:US
Practice Address - Phone:317-727-6795
Practice Address - Fax:317-769-7439
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003114A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist