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Individual
STACY SHEPHERD
Active
Individual
STACY SHEPHERD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45-3589857
THE HOLMAN GROUP
—
Enumeration date
10/04/2017
Last updated
07/03/2023
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