Provider Demographics
NPI:1518030832
Name:STANDARD, MISTY D (MS, CCC, SLP)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:D
Last Name:STANDARD
Suffix:
Gender:F
Credentials:MS, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7007 N 10TH ST
Mailing Address - Street 2:MILESTONES THERAPEUTIC ASSOCIATES INC.
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3104
Mailing Address - Country:US
Mailing Address - Phone:956-661-0475
Mailing Address - Fax:956-688-6781
Practice Address - Street 1:7007 N 10TH ST
Practice Address - Street 2:MILESTONES THERAPEUTIC ASSOCIATES INC.
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3104
Practice Address - Country:US
Practice Address - Phone:956-661-0475
Practice Address - Fax:956-688-6781
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16642174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143404501Medicaid