Provider Demographics
NPI:1427249689
Name:STOCKERT, MISTY JO (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:JO
Last Name:STOCKERT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:JO
Other - Last Name:SKAVLEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:201 14TH ST NW
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-2063
Mailing Address - Country:US
Mailing Address - Phone:701-663-4274
Mailing Address - Fax:
Practice Address - Street 1:986 2ND AVE W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-3916
Practice Address - Country:US
Practice Address - Phone:700-140-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND991235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist