Provider Demographics
NPI:1972777068
Name:STUTZMAN, STANLEY BRENT (MA,LP)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:BRENT
Last Name:STUTZMAN
Suffix:
Gender:M
Credentials:MA,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:POSTVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52162-0308
Mailing Address - Country:US
Mailing Address - Phone:563-864-7122
Mailing Address - Fax:563-864-7123
Practice Address - Street 1:301 12 PLACE NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912
Practice Address - Country:US
Practice Address - Phone:507-437-6927
Practice Address - Fax:507-437-6927
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3301103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily