Individual
CHARITY STANLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3202 N WISCONSIN AVE, PEORIA, IL 61603-1260
(309) 645-6030
Mailing address
3202 N WISCONSIN AVE, PEORIA, IL 61603-1260
(309) 645-6030
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
235Z00000X
—
IL
Enumeration date
11/20/2018
Last updated
11/20/2018
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