Provider Demographics
NPI:1538374244
Name:STANTON, RAYMOND MARK (BCHIS)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:MARK
Last Name:STANTON
Suffix:
Gender:M
Credentials:BCHIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7367 N US HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-8534
Mailing Address - Country:US
Mailing Address - Phone:812-418-3899
Mailing Address - Fax:
Practice Address - Street 1:1101 N NATIONAL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5586
Practice Address - Country:US
Practice Address - Phone:812-373-9006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001001237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist