MEDICARE: SOPHIA STANLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist
2	235Z00000X	Speech-Language Pathologist	40921	TX

General Provider Information

NPI Number	:	1205390416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA STANLEY

Provider Business Mailing Address
First Line	:	301 N COTTONWOOD DR
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75080-4712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5585 CARUTH HAVEN LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-8157
Country	:	US
Telephone Number	:	214-308-0083
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2019
Last Update Date	:	05/09/2022

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Directions to “ SOPHIA STANLEY ” Practice Location

Language	Start Address	Practice Location

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