Provider Demographics
NPI:1386984896
Name:STANLEY, JENNIFER KATHLEEN (MS)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KATHLEEN
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11103 JANET LEE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4225
Mailing Address - Country:US
Mailing Address - Phone:210-722-5015
Mailing Address - Fax:
Practice Address - Street 1:4600 LOCKHILL SELMA RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2186
Practice Address - Country:US
Practice Address - Phone:210-408-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107147235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist