Basic Information
| Provider Information | |||||||||
| NPI: | 1316249006 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOCKTON | ||||||||
| FirstName: | SHAD | ||||||||
| MiddleName: | RICK | ||||||||
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| Credential: | NBC-HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 W 6TH ST | ||||||||
| Address2: | SUITE H | ||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810032316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195432116 | ||||||||
| FaxNumber: | 7195432216 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 W 6TH ST | ||||||||
| Address2: | SUITE H | ||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810032316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195432116 | ||||||||
| FaxNumber: | 7195432216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2010 | ||||||||
| LastUpdateDate: | 08/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HAD-212 | CO | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.