Provider Demographics
NPI:1275218638
Name:SANTILLAN, STEPHANIE JACKLYN
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JACKLYN
Last Name:SANTILLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1151
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NE
Mailing Address - Zip Code:68748-1151
Mailing Address - Country:US
Mailing Address - Phone:402-378-6277
Mailing Address - Fax:
Practice Address - Street 1:301 E 12TH ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NE
Practice Address - Zip Code:68748-6441
Practice Address - Country:US
Practice Address - Phone:402-378-6277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst