Provider Demographics
NPI:1427729052
Name:STOCKDALL, JESSIE L (MSW)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:L
Last Name:STOCKDALL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:L
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:217 LAWTON AVE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-3918
Mailing Address - Country:US
Mailing Address - Phone:256-633-7900
Mailing Address - Fax:
Practice Address - Street 1:217 LAWTON AVE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-3918
Practice Address - Country:US
Practice Address - Phone:256-633-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE