Provider Demographics
NPI:1922484773
Name:STOCKTON, ALLISON MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:STOCKTON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SHAMROCK CT
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3190
Mailing Address - Country:US
Mailing Address - Phone:631-338-5931
Mailing Address - Fax:
Practice Address - Street 1:1 SHAMROCK CT
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3190
Practice Address - Country:US
Practice Address - Phone:631-338-5931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024741-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist