Provider Demographics
NPI:1063705507
Name:STONE OAKLEY, SYDNA (BCBA)
Entity type:Individual
Prefix:MRS
First Name:SYDNA
Middle Name:
Last Name:STONE OAKLEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4819 IHLES RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5900
Mailing Address - Country:US
Mailing Address - Phone:337-377-7772
Mailing Address - Fax:
Practice Address - Street 1:4819 IHLES RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5900
Practice Address - Country:US
Practice Address - Phone:337-377-7772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2351567Medicaid