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General NPI Number Information
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NPI Number | 1700956166
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Entity Type | Individual
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Provider Name | SUSAN WILLIAMS STANLEY MS, CCC, SLP
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Gender | Female
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1315 WALNUT ST
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City | TEXARKANA
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State | TX
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Zip | 75501-4446
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Country | US
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Telephone | 903-794-2705
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Fax | 903-793-1203
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Provider Business Mailing Address
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Address Line | 3 LADERA DR
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City | TEXARKANA
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State | TX
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Zip | 75503-1805
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Country | US
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Telephone | 903-793-5606
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Fax | 903-793-1203
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 14448
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP494
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License Number State | AR
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