Provider Demographics
NPI:1295070092
Name:STANFIELD, BRAD RAYMOND (BC-HIS)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:RAYMOND
Last Name:STANFIELD
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10848 ROSE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:IN
Mailing Address - Zip Code:46774-8912
Mailing Address - Country:US
Mailing Address - Phone:260-493-7742
Mailing Address - Fax:
Practice Address - Street 1:10848 ROSE AVE STE 3
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-8912
Practice Address - Country:US
Practice Address - Phone:260-493-7742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001100A237700000X, 332S00000X
OH2156237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No332S00000XSuppliersHearing Aid Equipment