Healthcare Provider Details

I. General information

NPI: 1689590887
Provider Name (Legal Business Name): ANDREW SCOT STANGL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 S 75TH ST
OMAHA NE
68124-1609
US

IV. Provider business mailing address

PO BOX 736707
CHICAGO IL
60673-6707
US

V. Phone/Fax

Practice location:
  • Phone: 402-259-6948
  • Fax: 855-915-0244
Mailing address:
  • Phone: 469-824-2196
  • Fax: 855-915-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT-26-512318
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: