Provider Demographics
NPI:1316926793
Name:STANTON, LETITIA ANTOINETTE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LETITIA
Middle Name:ANTOINETTE
Last Name:STANTON
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:PSC 836, BOX 0343
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09636-0343
Mailing Address - Country:US
Mailing Address - Phone:3909-537-0626
Mailing Address - Fax:
Practice Address - Street 1:PSC 836, BOX 2670
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09636-2670
Practice Address - Country:US
Practice Address - Phone:3909-556-4536
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 11733235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
09141061OtherASHA MEMBER NUMBER
CASP 11733OtherCALIFORNIA LICENSURE