1164583068 NPI number — VIRGINIA D. STOCKER VIRGINIA STOCKER

Table of content: VIRGINIA D. STOCKER VIRGINIA STOCKER (NPI 1164583068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164583068 NPI number — VIRGINIA D. STOCKER VIRGINIA STOCKER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOCKER
Provider First Name:
VIRGINIA
Provider Middle Name:
D.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
VIRGINIA STOCKER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LUECKE
Provider Other First Name:
VIRGINIA
Provider Other Middle Name:
D.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164583068
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
845 E GLEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITEFISH BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53217-5217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-962-1947
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3970 N OAKLAND AVE
Provider Second Line Business Practice Location Address:
#502
Provider Business Practice Location Address City Name:
SHOREWOOD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53211-2265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-332-2548
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2006

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: 1041C0700X , with the licence number:  338-128 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com