MEDICARE: IMANI STANFORD

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1225963952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMANI STANFORD

Provider Business Mailing Address
First Line	:	4721 S CLIFF AVE STE 103
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055-6969
Country	:	US
Telephone Number	:	816-608-1956
Fax Number	:	800-687-5070

Provider Business Practice Location Address
First Line	:	12100 SAINT CHARLES ROCK RD UNIT 5
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2601
Country	:	US
Telephone Number	:	636-398-2500
Fax Number	:	800-687-5070

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

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

Similar Medicare Providers

1952234296 — JASMINE CHAMBERLAIN
Practice Location Address:

12100 SAINT CHARLES ROCK RD UNIT 5
BRIDGETON, MO
63044-2601

Practice Phone: 636-398-2500
Practice Fax: 800-687-5070

1003749342 — CHRISTINA DESALVO
Practice Location Address:

12100 SAINT CHARLES ROCK RD UNIT 5
BRIDGETON, MO
63044-2601

Practice Phone: 636-398-2500
Practice Fax: 800-687-5070

1518890862 — QUINCY JONES
Practice Location Address:

12100 SAINT CHARLES ROCK RD UNIT 5
BRIDGETON, MO
63044-2601

Practice Phone: 636-398-2500
Practice Fax: 800-687-5070

1689921314 — DR. TAREQ I. NABHAN O.D.
Practice Location Address:

12110 SAINT CHARLES ROCK RD
BRIDGETON, MO
63044-2601

Practice Phone: 314-291-3700
Practice Fax:

1053702381 — CRESCENT EYECARE
Practice Location Address:

12110 SAINT CHARLES ROCK RD
BRIDGETON, MO
63044-2601

Practice Phone: 314-291-3700
Practice Fax: 314-291-3708

1407300429 — NICOLE BECKER DPT
Practice Location Address:

12108 SAINT CHARLES ROCK RD , 110
BRIDGETON, MO
63044-2601

Practice Phone: 314-739-2020
Practice Fax:

Directions to “ IMANI STANFORD ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.