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General NPI Number Information
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NPI Number | 1730858200
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Entity Type | Individual
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Provider Name | STEPHANIE MARIE DELONG M.S., BCBA
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Gender | Female
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Dates
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Enumeration Date | 09/08/2021
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 20890 KENBRIDGE CT
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City | LAKEVILLE
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State | MN
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Zip | 55044-8041
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Country | US
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Telephone | 612-355-8865
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Fax |
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Provider Business Mailing Address
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Address Line | 4196 HILLTOP LN
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City | EAGAN
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State | MN
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Zip | 55123-1440
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Country | US
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Telephone | 763-567-3967
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BACB552694
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License Number State | MN
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