Provider Demographics
NPI:1386498772
Name:STANSBURY, AMBER JEAN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:JEAN
Last Name:STANSBURY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 BETH WAY
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-1775
Mailing Address - Country:US
Mailing Address - Phone:909-843-5968
Mailing Address - Fax:
Practice Address - Street 1:2055 YORK AVE
Practice Address - Street 2:111
Practice Address - City:VANCOUVER
Practice Address - State:BRITISH COLUMBIA
Practice Address - Zip Code:V6J1E5
Practice Address - Country:CA
Practice Address - Phone:909-843-5968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36960235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist