Provider Demographics
NPI:1720663941
Name:OWSIANY, STACEY LYNNE (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNNE
Last Name:OWSIANY
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LYNNE
Other - Last Name:SIDEBOTTOM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10650 E BETHANY DRIVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-8005
Mailing Address - Country:US
Mailing Address - Phone:800-536-2340
Mailing Address - Fax:
Practice Address - Street 1:10650 E BETHANY DRIVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-8005
Practice Address - Country:US
Practice Address - Phone:800-536-2340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-18-33667103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst