Provider Demographics
NPI:1134242241
Name:STANLEY, CRISTINA EUGENIO (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:EUGENIO
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8769 W NORTHVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-6938
Mailing Address - Country:US
Mailing Address - Phone:623-203-4109
Mailing Address - Fax:623-547-6473
Practice Address - Street 1:8769 W NORTHVIEW AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-6938
Practice Address - Country:US
Practice Address - Phone:623-203-4109
Practice Address - Fax:623-547-6473
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0242235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ451633Medicaid