Provider Demographics
NPI:1801078738
Name:STOKES, RUSTIN ORVIL (MS, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:RUSTIN
Middle Name:ORVIL
Last Name:STOKES
Suffix:
Gender:M
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 1:973 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-3145
Mailing Address - Country:US
Mailing Address - Phone:435-723-2727
Mailing Address - Fax:435-723-0448
Practice Address - Street 1:973 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-3145
Practice Address - Country:US
Practice Address - Phone:435-723-2727
Practice Address - Fax:435-723-0448
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6749498-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist