Provider Demographics
NPI:1891096905
Name:VANELLA, STANLEY A (MS)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:A
Last Name:VANELLA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4447
Mailing Address - Country:US
Mailing Address - Phone:707-442-2774
Mailing Address - Fax:707-442-1834
Practice Address - Street 1:605 HARRIS ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4447
Practice Address - Country:US
Practice Address - Phone:707-442-2774
Practice Address - Fax:707-442-1834
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12611235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist