Healthcare Provider Details

I. General information

NPI: 1841804705
Provider Name (Legal Business Name): JOSEPH STOCKTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/08/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 KLOTZ RD
BOWLING GREEN OH
43402-4820
US

IV. Provider business mailing address

1045 KLOTZ RD
BOWLING GREEN OH
43402-4820
US

V. Phone/Fax

Practice location:
  • Phone: 419-352-7588
  • Fax: 419-354-4977
Mailing address:
  • Phone: 419-352-7588
  • Fax: 419-354-4977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2004774
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: