Healthcare Provider Details

I. General information

NPI: 1750036679
Provider Name (Legal Business Name): STEPHANIE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 E PRIMROSE ST
SPRINGFIELD MO
65807-5254
US

IV. Provider business mailing address

4700 N 22ND ST APT G05
OZARK MO
65721-7461
US

V. Phone/Fax

Practice location:
  • Phone: 620-755-0003
  • Fax:
Mailing address:
  • Phone: 620-755-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2024033963
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: