Provider Demographics
NPI:1033412119
Name:STOCKLIN, WENDEE KAY (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:WENDEE
Middle Name:KAY
Last Name:STOCKLIN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GOSHAWK CT.
Mailing Address - Street 2:P.O. BOX 488
Mailing Address - City:WALLACE
Mailing Address - State:CA
Mailing Address - Zip Code:95254
Mailing Address - Country:US
Mailing Address - Phone:209-763-5420
Mailing Address - Fax:209-763-5420
Practice Address - Street 1:4 GOSHAWK CT.
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:CA
Practice Address - Zip Code:95254
Practice Address - Country:US
Practice Address - Phone:209-763-5420
Practice Address - Fax:209-763-5420
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1096618103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst