Individual
AUDRA MARIE STANCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA, MPA
Contact information
Practice address
2310 W STARR ST, PEORIA, IL 61605-3240
(510) 563-9785
Mailing address
PO BOX 4792, STOCKTON, CA 95204-0792
(510) 563-9785
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/24/2021
Last updated
06/24/2021
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