Provider Demographics
NPI:1578068821
Name:STABENAU, AMBER LYNN (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:STABENAU
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8224 BURKSHIRE CIR APT 203
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-1835
Mailing Address - Country:US
Mailing Address - Phone:810-358-4808
Mailing Address - Fax:
Practice Address - Street 1:338 BROADWAY ST STE 301
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-7331
Practice Address - Country:US
Practice Address - Phone:573-225-6678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133002326103K00000X
MI7401001221103K00000X
MO2022000275103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst