1063551984 NPI number — MRS. KIMBERLY L STOCKER M.A., CCC-SLP

Table of content: MRS. KIMBERLY L STOCKER M.A., CCC-SLP (NPI 1063551984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063551984 NPI number — MRS. KIMBERLY L STOCKER M.A., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOCKER
Provider First Name:
KIMBERLY
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STOCKER
Provider Other First Name:
KIM
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A., CCC-SLP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1063551984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
934 MYSTIC VILLAGE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEABROOK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77586-2581
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-291-8431
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17045 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-480-5648
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  18159 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 18159 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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