Provider Demographics
NPI:1366086696
Name:STANTON, MARY CHRISTINE
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CHRISTINE
Last Name:STANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:STANTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:EDMESTON CENTRAL SCHOOL 11 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:EDMESTON
Mailing Address - State:NY
Mailing Address - Zip Code:13335-2303
Mailing Address - Country:US
Mailing Address - Phone:607-965-8931
Mailing Address - Fax:
Practice Address - Street 1:11 NORTH STREET
Practice Address - Street 2:
Practice Address - City:EDMESTON
Practice Address - State:NY
Practice Address - Zip Code:13335
Practice Address - Country:US
Practice Address - Phone:607-965-8931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant