Provider Demographics
NPI:1043985443
Name:HAMILTON, STEPHANIE (BCBA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 E 600TH RD
Mailing Address - Street 2:
Mailing Address - City:CASEY
Mailing Address - State:IL
Mailing Address - Zip Code:62420-3312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1534 E 600TH RD
Practice Address - Street 2:
Practice Address - City:CASEY
Practice Address - State:IL
Practice Address - Zip Code:62420-3312
Practice Address - Country:US
Practice Address - Phone:239-240-9954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-20-43936103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst