Provider Demographics
NPI:1558673004
Name:STANLEY, KARIN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:STANLEY
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 1:17 FIRETHORN
Mailing Address - Street 2:
Mailing Address - City:RSM
Mailing Address - State:CA
Mailing Address - Zip Code:92688-1238
Mailing Address - Country:US
Mailing Address - Phone:949-637-2637
Mailing Address - Fax:
Practice Address - Street 1:25 SPECTRUM POINTE DR STE 405
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2276
Practice Address - Country:US
Practice Address - Phone:949-637-2637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11582235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist