Provider Demographics
NPI:1316281876
Name:STOCKDILL, CECILIA ILENE (MS, SLP)
Entity type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:ILENE
Last Name:STOCKDILL
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 SUNNYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6332
Mailing Address - Country:US
Mailing Address - Phone:208-467-7298
Mailing Address - Fax:
Practice Address - Street 1:2609 SUNNYBROOK DR
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6332
Practice Address - Country:US
Practice Address - Phone:208-467-7298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDTSLP-2209235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist