Provider Demographics
NPI:1164805065
Name:VOLK, STEPHANIE L (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:VOLK
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:L
Other - Last Name:VOLK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED,BCBA
Mailing Address - Street 1:1720 S MARSHALL RD TRLR 19
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-7346
Mailing Address - Country:US
Mailing Address - Phone:651-354-3347
Mailing Address - Fax:
Practice Address - Street 1:1720 S MARSHALL RD TRLR 19
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-7346
Practice Address - Country:US
Practice Address - Phone:651-354-3347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-14-16572103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst