Provider Demographics
NPI:1013667351
Name:BELL, STEPHANIE REBECCA (BCBA, MED)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:REBECCA
Last Name:BELL
Suffix:
Gender:F
Credentials:BCBA, MED
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:HAVENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1375 BONITA AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5505
Mailing Address - Country:US
Mailing Address - Phone:571-286-6859
Mailing Address - Fax:
Practice Address - Street 1:1375 BONITA AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5505
Practice Address - Country:US
Practice Address - Phone:157-128-6685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-B-10220939103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORABA-B-10220939OtherBEHAVIOR ANALYST STATE LICENSE
1-21-55723OtherBEHAVIOR ANALYST CERTIFICATION BOARD