Provider Demographics
NPI:1093155798
Name:ROCKHOLD, STACIA D
Entity Type:Individual
Prefix:MRS
First Name:STACIA
Middle Name:D
Last Name:ROCKHOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 NEWCASTLE DR
Mailing Address - Street 2:
Mailing Address - City:MACKINAW
Mailing Address - State:IL
Mailing Address - Zip Code:61755-7648
Mailing Address - Country:US
Mailing Address - Phone:309-359-8736
Mailing Address - Fax:
Practice Address - Street 1:508 NEWCASTLE DR
Practice Address - Street 2:
Practice Address - City:MACKINAW
Practice Address - State:IL
Practice Address - Zip Code:61755-7648
Practice Address - Country:US
Practice Address - Phone:309-359-8736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist