Provider Demographics
NPI:1700956166
Name:STANLEY, SUSAN WILLIAMS (MS, CCC, SLP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:WILLIAMS
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 1:3 LADERA DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-1805
Mailing Address - Country:US
Mailing Address - Phone:903-793-5606
Mailing Address - Fax:903-793-1203
Practice Address - Street 1:1315 WALNUT ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-4446
Practice Address - Country:US
Practice Address - Phone:903-794-2705
Practice Address - Fax:903-793-1203
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14448235Z00000X
ARSP494235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR98946OtherARKANSAS BCBS
01070105OtherASHA CERTIFICATION
TX80093TOtherTEXAS BCBS