Healthcare Provider Details

I. General information

NPI: 1073150728
Provider Name (Legal Business Name): STEFFEN POPE WILSON PH.D., BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 LEXINGTON RD
RICHMOND KY
40475-1059
US

IV. Provider business mailing address

3834 PINE RIDGE WAY
LEXINGTON KY
40514-1770
US

V. Phone/Fax

Practice location:
  • Phone: 859-624-2454
  • Fax:
Mailing address:
  • Phone: 859-536-1527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number252438
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: