Healthcare Provider Details

I. General information

NPI: 1386575017
Provider Name (Legal Business Name): LAUREL R STOCKWELL M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 E J ST
CHULA VISTA CA
91910-6115
US

IV. Provider business mailing address

1220 S GREENSVIEW DR
CHULA VISTA CA
91915-2127
US

V. Phone/Fax

Practice location:
  • Phone: 619-425-9600
  • Fax:
Mailing address:
  • Phone: 619-656-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14316931
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: