Provider Demographics
NPI:1669117305
Name:STOCKDALE, MEGHAN M (LAC)
Entity type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:M
Last Name:STOCKDALE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 ARTEMIS CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2841
Mailing Address - Country:US
Mailing Address - Phone:970-846-6912
Mailing Address - Fax:
Practice Address - Street 1:108 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2403
Practice Address - Country:US
Practice Address - Phone:970-846-6912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002727171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist