Provider Demographics
NPI:1083247241
Name:MCMAHON, STEPHANIE (BCBA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:SYLVESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:490 BRAD ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:MN
Mailing Address - Zip Code:55339-9741
Mailing Address - Country:US
Mailing Address - Phone:612-964-9590
Mailing Address - Fax:
Practice Address - Street 1:490 BRAD ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:MN
Practice Address - Zip Code:55339-9741
Practice Address - Country:US
Practice Address - Phone:612-964-9590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-19-97376OtherREGISTERED BEHAVIOR TECHNITION CERTIFICATION