Provider Demographics
NPI:1891535472
Name:STOCKER, VIVICA (CCC,SLP)
Entity type:Individual
Prefix:
First Name:VIVICA
Middle Name:
Last Name:STOCKER
Suffix:
Gender:F
Credentials:CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:958 ASHEVILLE AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-0813
Mailing Address - Country:US
Mailing Address - Phone:803-719-1316
Mailing Address - Fax:
Practice Address - Street 1:356 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4064
Practice Address - Country:US
Practice Address - Phone:803-661-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8499235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist