Provider Demographics
NPI:1538503388
Name:STANGELAND, LINDSAY ALYNE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:ALYNE
Last Name:STANGELAND
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:ALYNE
Other - Last Name:MAJORS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:8500 N KNOXVILLE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-2079
Mailing Address - Country:US
Mailing Address - Phone:800-773-1682
Mailing Address - Fax:
Practice Address - Street 1:8500 N KNOXVILLE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2079
Practice Address - Country:US
Practice Address - Phone:800-773-1682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-10-7055103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst