Provider Demographics
NPI:1275328536
Name:STAMBAUGH, IAN PAUL
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:PAUL
Last Name:STAMBAUGH
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 1:4769 WHITESBURG DR SE STE 202
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1684
Mailing Address - Country:US
Mailing Address - Phone:256-666-0477
Mailing Address - Fax:256-666-0465
Practice Address - Street 1:4769 WHITESBURG DR SE STE 202
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1684
Practice Address - Country:US
Practice Address - Phone:256-666-0477
Practice Address - Fax:256-666-0465
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician