Provider Demographics
NPI:1689877110
Name:MEAD, STANFORD NEAD (CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:STANFORD
Middle Name:NEAD
Last Name:MEAD
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:STAN
Other - Middle Name:N
Other - Last Name:MEAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1308 EAST FAIRBANKS STREET
Mailing Address - Street 2:UNIT B
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404
Mailing Address - Country:US
Mailing Address - Phone:253-334-8409
Mailing Address - Fax:
Practice Address - Street 1:1308 E FAIRBANKS ST
Practice Address - Street 2:UNIT B
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-3808
Practice Address - Country:US
Practice Address - Phone:253-334-8409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003733235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist