Healthcare Provider Details

I. General information

NPI: 1609488501
Provider Name (Legal Business Name): STEPHANIE FOWLER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 72ND AVE
PLEASANT PRAIRIE WI
53158-2911
US

IV. Provider business mailing address

10450 72ND AVE
PLEASANT PRAIRIE WI
53158-2911
US

V. Phone/Fax

Practice location:
  • Phone: 262-657-6453
  • Fax: 262-671-5013
Mailing address:
  • Phone: 262-657-6453
  • Fax: 262-671-5013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1534140
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: