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NPI Code Detail

MEDICARE: STEPHANIE JEAN SMOTHERMON BCBA

MEDICARE: STEPHANIE JEAN SMOTHERMON 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
1103K00000XBehavior Analyst1165TX

General Provider Information

NPI Number : 1588205793
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE JEAN SMOTHERMON BCBA
Provider Business Mailing Address
First Line : 4910 AIRPORT AVE STE D
Second Line :
City : ROSENBERG
State : TX
Zip : 77471-5759
Country : US
Telephone Number : 281-239-1445
Fax Number : 281-239-0828
Provider Business Practice Location Address
First Line : 4910 AIRPORT AVE STE F
Second Line :
City : ROSENBERG
State : TX
Zip : 77471-5759
Country : US
Telephone Number : 281-239-1497
Fax Number : 281-238-6769
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2019
Last Update Date : 12/19/2025

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Directions to “ STEPHANIE JEAN SMOTHERMON BCBA” Practice Location

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