MEDICARE: STEPHANIE JEAN WILSON

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	003394	NY
2	103K00000X	Behavior Analyst	1-21-47111

General Provider Information

NPI Number	:	1558945725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE JEAN WILSON

Provider Business Mailing Address
First Line	:	106 ARABELLA DR
Second Line	:
City	:	PIEDMONT
State	:	SC
Zip	:	29673-9928
Country	:	US
Telephone Number	:	724-393-7847
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 ARABELLA DR
Second Line	:
City	:	PIEDMONT
State	:	SC
Zip	:	29673-9928
Country	:	US
Telephone Number	:	724-393-7847
Fax Number	:

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

Provider Enumeration Date	:	05/12/2021
Last Update Date	:	06/18/2026

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Directions to “ STEPHANIE JEAN WILSON ” Practice Location

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