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NPI Code Detail

MEDICARE: MRS. BECKY STAUDACHER MS, BCBA

MEDICARE: MRS. BECKY STAUDACHER MS, BCBA
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
1247200000XOther Technician
2103K00000XBehavior Analyst7401000980MI

General Provider Information

NPI Number : 1518328657
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BECKY STAUDACHER MS, BCBA
Provider Business Mailing Address
First Line : 7712 UNICORN TAPESTRY CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89149-0437
Country : US
Telephone Number : 734-945-6473
Fax Number :
Provider Business Practice Location Address
First Line : 7712 UNICORN TAPESTRY CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89149-0437
Country : US
Telephone Number : 734-945-6473
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2016
Last Update Date : 12/14/2021

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