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NPI Code Detail

MEDICARE: MRS. STEPHANIE ELLEN LOPEZ MA, BCBA, LBA

MEDICARE: MRS. STEPHANIE ELLEN LOPEZ MA, BCBA, LBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2103K00000XBehavior AnalystLBA0528MN

General Provider Information

NPI Number : 1235806902
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STEPHANIE ELLEN LOPEZ MA, BCBA, LBA
Provider Business Mailing Address
First Line : 2080 WOODDALE DR STE 200
Second Line :
City : WOODBURY
State : MN
Zip : 55125-2920
Country : US
Telephone Number : 612-201-2468
Fax Number :
Provider Business Practice Location Address
First Line : 2080 WOODDALE DR STE 200
Second Line :
City : WOODBURY
State : MN
Zip : 55125-2920
Country : US
Telephone Number : 612-201-2468
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2021
Last Update Date : 02/14/2025

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