Provider Demographics
NPI:1962472118
Name:STOCKWELL, MARSHA LEDHU (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:LEDHU
Last Name:STOCKWELL
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 GRACEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147
Mailing Address - Country:US
Mailing Address - Phone:704-856-1781
Mailing Address - Fax:704-855-7881
Practice Address - Street 1:1260 GRACEBROOK DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147
Practice Address - Country:US
Practice Address - Phone:704-856-1781
Practice Address - Fax:704-855-7881
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2016235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412366Medicaid