Provider Demographics
NPI:1740642636
Name:STOCKERT, CHERICE MARIE
Entity type:Individual
Prefix:
First Name:CHERICE
Middle Name:MARIE
Last Name:STOCKERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHERICE
Other - Middle Name:MARIE
Other - Last Name:PULLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21412 9TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-7607
Mailing Address - Country:US
Mailing Address - Phone:206-227-9644
Mailing Address - Fax:
Practice Address - Street 1:1240 116TH AVE NE
Practice Address - Street 2:SUITE 102
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3815
Practice Address - Country:US
Practice Address - Phone:206-437-5412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst