Healthcare Provider Details

I. General information

NPI: 1578110755
Provider Name (Legal Business Name): REYNA STEVENS MA, BCBA LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4006 WASHINGTON RD STE A
KENOSHA WI
53144-4819
US

IV. Provider business mailing address

606 PARK ST
GENOA CITY WI
53128-2034
US

V. Phone/Fax

Practice location:
  • Phone: 920-857-9041
  • Fax: 920-857-3366
Mailing address:
  • Phone: 815-575-2375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: