Provider Demographics
NPI:1265123087
Name:STANLEY, RYAN TOM (AUD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:TOM
Last Name:STANLEY
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2632 BROADWAY ST STE 102S
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1138
Mailing Address - Country:US
Mailing Address - Phone:210-451-0373
Mailing Address - Fax:210-451-0368
Practice Address - Street 1:2632 BROADWAY ST STE 102S
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1138
Practice Address - Country:US
Practice Address - Phone:210-451-0373
Practice Address - Fax:210-451-0368
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81509231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist