Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106E00000X | Assistant Behavior Analyst | ||
Y | 106S00000X | Behavior Technician |
NPI | 1114414612 |
---|---|
Provider Name | Stephanie Lynn Roberts |
First Address | Colorado Springs, CO 80918-3488 |
Second Address | Colorado Springs, CO 80918-3488 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2018 |
Last Update Date | 12/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1437321189 | (05) | CO |