Provider Demographics
NPI:1679992101
Name:STOCKSTILL, KELLY MCGRATH (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MCGRATH
Last Name:STOCKSTILL
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 1:1053 53RD ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-4005
Mailing Address - Country:US
Mailing Address - Phone:769-203-0920
Mailing Address - Fax:
Practice Address - Street 1:474 TARRANT RD
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2947
Practice Address - Country:US
Practice Address - Phone:769-203-0920
Practice Address - Fax:205-423-5005
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-13
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3902235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist