MEDICARE: MRS. STEPHENIE JO ILAGAN BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	15530	CA

General Provider Information

NPI Number	:	1457581407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHENIE JO ILAGAN BCBA

Provider Business Mailing Address
First Line	:	302 N EL CAMINO REAL STE 202
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92672-4778
Country	:	US
Telephone Number	:	949-292-2852
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 N EL CAMINO REAL STE 202
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92672-4778
Country	:	US
Telephone Number	:	949-292-2852
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2009
Last Update Date	:	05/21/2026

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