Individual
STEPHANIE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3904 SEASONS PT, EVANSVILLE, IN 47715-1389
(317) 407-0383
Mailing address
3904 SEASONS PT, EVANSVILLE, IN 47715-1389
(317) 407-0383
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BACB236013
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200815440
—
IN
Enumeration date
03/14/2007
Last updated
01/07/2019
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