Provider Demographics
NPI:1619204039
Name:STONEKING, RICHARD TODD
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:TODD
Last Name:STONEKING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17386 W BUCKHORN TRL
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-1019
Mailing Address - Country:US
Mailing Address - Phone:623-546-3202
Mailing Address - Fax:
Practice Address - Street 1:17386 W BUCKHORN TRL
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85387-1019
Practice Address - Country:US
Practice Address - Phone:623-546-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1963339385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child