Provider Demographics
NPI:1740587658
Name:STINSON, RICKY MATHIS II
Entity Type:Individual
Prefix:MR
First Name:RICKY
Middle Name:MATHIS
Last Name:STINSON
Suffix:II
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 1:100 E PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-0704
Mailing Address - Country:US
Mailing Address - Phone:410-825-9445
Mailing Address - Fax:
Practice Address - Street 1:100 E PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-0704
Practice Address - Country:US
Practice Address - Phone:410-825-9445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-13
Last Update Date:2011-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06306235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist