Provider Demographics
NPI:1225474570
Name:STORDAHL, STEPHANY (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:STEPHANY
Middle Name:
Last Name:STORDAHL
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:STEPHANY
Other - Middle Name:
Other - Last Name:REETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1412 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54603-2403
Mailing Address - Country:US
Mailing Address - Phone:715-210-9100
Mailing Address - Fax:
Practice Address - Street 1:901 CALEDONIA ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-2616
Practice Address - Country:US
Practice Address - Phone:608-785-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI71140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst