Provider Demographics
NPI:1154760635
Name:STOCKHAM, SONA MARIE (BA PLUS 45)
Entity type:Individual
Prefix:MS
First Name:SONA
Middle Name:MARIE
Last Name:STOCKHAM
Suffix:
Gender:F
Credentials:BA PLUS 45
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 N ADAIR ST
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-2803
Mailing Address - Country:US
Mailing Address - Phone:918-256-3590
Mailing Address - Fax:
Practice Address - Street 1:327 N ADAIR ST
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-2803
Practice Address - Country:US
Practice Address - Phone:918-256-3590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator