MEDICARE: KATHLEEN STANLEY M.A., CCC-SLP

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	7101002441	MI

General Provider Information

NPI Number	:	1568915551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN STANLEY M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	20925 LAKELAND ST
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-3364
Country	:	US
Telephone Number	:	586-405-5354
Fax Number	:

Provider Business Practice Location Address
First Line	:	20925 LAKELAND ST
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-3364
Country	:	US
Telephone Number	:	586-405-5354
Fax Number	:

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

Provider Enumeration Date	:	07/26/2016
Last Update Date	:	07/26/2016

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