Provider Demographics
NPI:1477281137
Name:STUTHEIT, FALLON DENEANE (RBT)
Entity Type:Individual
Prefix:
First Name:FALLON
Middle Name:DENEANE
Last Name:STUTHEIT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-4441
Mailing Address - Country:US
Mailing Address - Phone:402-414-2459
Mailing Address - Fax:
Practice Address - Street 1:406 W 25TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-4441
Practice Address - Country:US
Practice Address - Phone:402-414-2459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician