Provider Demographics
NPI:1275657272
Name:STANLEY, ANGELA C (PSYD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:STANLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W178N9912 RIVERCREST DR STE 108
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-4662
Mailing Address - Country:US
Mailing Address - Phone:262-229-5581
Mailing Address - Fax:
Practice Address - Street 1:W178N9912 RIVERCREST DR STE 108
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-4662
Practice Address - Country:US
Practice Address - Phone:262-229-5581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2751-057103TC2200X
WI2751103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39160100Medicaid