Provider Demographics
NPI:1821335860
Name:STANSFIELD, MARILYN RUBY (MS CFY)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:RUBY
Last Name:STANSFIELD
Suffix:
Gender:F
Credentials:MS CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 CASA GRANDE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2614
Mailing Address - Country:US
Mailing Address - Phone:408-497-2382
Mailing Address - Fax:
Practice Address - Street 1:5825 CASA GRANDE AVE
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2614
Practice Address - Country:US
Practice Address - Phone:408-497-2382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.002539235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist