Individual
STACEY LYNN SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., BCBA, QMHP
Contact information
Practice address
902 W MAIN ST, C/O STACEY L. SMALL, WEST FRANKFORT, IL 62896-2210
(618) 201-6061
Mailing address
2300 S ILLINOIS AVE, APT B6, CARBONDALE, IL 62903-5932
(618) 201-6061
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-13-12970
IL
Other
Enumeration date
11/07/2013
Last updated
11/07/2013
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