Provider Demographics
NPI:1992163661
Name:STANLEY, MARY (MA CCC SLP)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16685 S LIND RD
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-7870
Mailing Address - Country:US
Mailing Address - Phone:816-785-7821
Mailing Address - Fax:
Practice Address - Street 1:13418 SANTA FE TRAIL DR
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3655
Practice Address - Country:US
Practice Address - Phone:913-689-8272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011003504235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist