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General NPI Number Information
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NPI Number | 1790345114
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Entity Type | Individual
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Provider Name | STACY RYAN DOW M.S., BCBA, LBA
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Gender | Male
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 3301 N 3RD ST
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City | ABILENE
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State | TX
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Zip | 79603-7054
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Country | US
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Telephone | 855-832-6727
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Fax |
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Provider Business Mailing Address
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Address Line | 7108 S KANNER HWY
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City | STUART
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State | FL
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Zip | 34997-7462
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Country | US
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Telephone | 855-832-6727
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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 | 2052
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License Number State | TX
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