MEDICARE: STEPHANIE ELKIN

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1831823863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ELKIN

Provider Business Mailing Address
First Line	:	5400 MONTGOMERY BLVD NE APT 402B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-1312
Country	:	US
Telephone Number	:	505-357-7675
Fax Number	:

Provider Business Practice Location Address
First Line	:	5400 MONTGOMERY BLVD NE APT 402B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-1312
Country	:	US
Telephone Number	:	505-357-7722
Fax Number	:

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

Provider Enumeration Date	:	07/14/2022
Last Update Date	:	07/14/2022

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Directions to “ STEPHANIE ELKIN ” Practice Location

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