Provider Demographics
NPI:1013194364
Name:STOCKSTILL, NICOLE (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:STOCKSTILL
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36298 E PINE GROVE CT
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3466
Mailing Address - Country:US
Mailing Address - Phone:225-288-0079
Mailing Address - Fax:
Practice Address - Street 1:535 W ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-7844
Practice Address - Country:US
Practice Address - Phone:225-343-4232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4389237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA12202657OtherCAQH