Provider Demographics
NPI:1760544183
Name:STANLEY, STACIA SYDELLE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STACIA
Middle Name:SYDELLE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:STACIA
Other - Middle Name:SYDELLE
Other - Last Name:IVENER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:690 E WARNER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3055
Mailing Address - Country:US
Mailing Address - Phone:480-820-6366
Mailing Address - Fax:480-820-0462
Practice Address - Street 1:690 E WARNER RD STE 105
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3055
Practice Address - Country:US
Practice Address - Phone:480-820-6366
Practice Address - Fax:480-820-0462
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP5241235Z00000X
AZ235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist