Provider Demographics
NPI:1043765993
Name:STOICK, KRISTIN SHARON (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:SHARON
Last Name:STOICK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:SHRON
Other - Last Name:LAFRATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:2706 N FRANCISCO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1706
Mailing Address - Country:US
Mailing Address - Phone:713-294-0718
Mailing Address - Fax:
Practice Address - Street 1:3709 N KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4503
Practice Address - Country:US
Practice Address - Phone:773-377-5492
Practice Address - Fax:773-303-8422
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111415235Z00000X
IL146.013641235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146.013641OtherSTATE LICENSE
TX111415OtherSTATE LICENSE