Provider Demographics
NPI:1205638988
Name:STANLEY, AUDRA R
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:R
Last Name:STANLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3755 7TH AVE E
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-2300
Mailing Address - Country:US
Mailing Address - Phone:701-260-4899
Mailing Address - Fax:
Practice Address - Street 1:135 SIMS ST STE 202
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5148
Practice Address - Country:US
Practice Address - Phone:701-264-9049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker