Provider Demographics
NPI:1568750099
Name:GREGORY, STEPHANIE A (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:JAGGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:2250 S ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2556
Mailing Address - Country:US
Mailing Address - Phone:856-803-0102
Mailing Address - Fax:
Practice Address - Street 1:901 ENGLEWOOD PKWY
Practice Address - Street 2:SUITE 118
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2305
Practice Address - Country:US
Practice Address - Phone:303-935-5200
Practice Address - Fax:303-648-5002
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-11-8500103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst