MEDICARE: DELANNA STEVENS

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
1	103K00000X	Behavior Analyst	1-16-23128	AR
2	103K00000X	Behavior Analyst	1-16-23128	TX

General Provider Information

NPI Number	:	1508318759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELANNA STEVENS

Provider Business Mailing Address
First Line	:	1022 JONES RD
Second Line	:	SUITE 2
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-0705
Country	:	US
Telephone Number	:	479-310-6505
Fax Number	:	479-763-0059

Provider Business Practice Location Address
First Line	:	1022 JONES RD
Second Line	:	SUITE 2
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-0705
Country	:	US
Telephone Number	:	479-310-6505
Fax Number	:	479-763-0059

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2016
Last Update Date	:	05/06/2017

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Directions to “ DELANNA STEVENS ” Practice Location

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