Provider Demographics
NPI:1659937837
Name:STANFORD, KATHLEEN ELISE (AUDIOLOGIST)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ELISE
Last Name:STANFORD
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:103 SUBURBAN RD STE 101D
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5581
Mailing Address - Country:US
Mailing Address - Phone:865-769-0283
Mailing Address - Fax:865-769-0281
Practice Address - Street 1:103 SUBURBAN RD STE 101D
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5581
Practice Address - Country:US
Practice Address - Phone:865-769-0283
Practice Address - Fax:865-769-0281
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81030OtherAUDIOLOGY LICENSE