Provider Demographics
NPI:1396799680
Name:STOCKTON, MARY DIANE (MS)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:DIANE
Last Name:STOCKTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 WINSLET DR
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-5546
Mailing Address - Country:US
Mailing Address - Phone:405-391-6125
Mailing Address - Fax:405-391-6125
Practice Address - Street 1:921 NE 13TH ST
Practice Address - Street 2:126
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5007
Practice Address - Country:US
Practice Address - Phone:405-270-0501
Practice Address - Fax:405-552-4365
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK946235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist