Healthcare Provider Details

I. General information

NPI: 1942922653
Provider Name (Legal Business Name): AUDREY RAE STOKER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUDREY RAE LYON

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W GEORGIA AVE
NAMPA ID
83686-2835
US

IV. Provider business mailing address

449 S FITNESS PL
EAGLE ID
83616-6828
US

V. Phone/Fax

Practice location:
  • Phone: 425-368-3262
  • Fax:
Mailing address:
  • Phone: 480-490-8715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number1-24-77690
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: