Provider Demographics
NPI:1063881621
Name:STOCKIE, KORI
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:
Last Name:STOCKIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 W VILLARD ST
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-5121
Mailing Address - Country:US
Mailing Address - Phone:701-225-1050
Mailing Address - Fax:701-227-6225
Practice Address - Street 1:135 W VILLARD ST
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5121
Practice Address - Country:US
Practice Address - Phone:701-225-1050
Practice Address - Fax:701-227-6225
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1754101YA0400X
ND780-3-15-14-263101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)