Provider Demographics
NPI:1669662607
Name:STANLEY, EDITH ANN (HIS)
Entity Type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:ANN
Last Name:STANLEY
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W EVERLY BROTHERS BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42330-1819
Mailing Address - Country:US
Mailing Address - Phone:270-754-2268
Mailing Address - Fax:270-754-1468
Practice Address - Street 1:1001 W EVERLY BROTHERS BLVD
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:KY
Practice Address - Zip Code:42330-1819
Practice Address - Country:US
Practice Address - Phone:270-754-2268
Practice Address - Fax:270-754-1468
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0524237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0524OtherSTATE LICENSE