Provider Demographics
NPI:1649927955
Name:BYRON-STANLEY, XAKEILA-LEE (SLP)
Entity type:Individual
Prefix:
First Name:XAKEILA-LEE
Middle Name:
Last Name:BYRON-STANLEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 36TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4741
Mailing Address - Country:US
Mailing Address - Phone:503-769-7131
Mailing Address - Fax:
Practice Address - Street 1:1750 WILCO RD
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-1085
Practice Address - Country:US
Practice Address - Phone:803-769-7131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17237235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist