Provider Demographics
NPI:1306643614
Name:JAMISON, STEPHANIE (RBT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:JAMISON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 LIGHTHOUSE DR APT 101
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-6923
Mailing Address - Country:US
Mailing Address - Phone:219-381-6001
Mailing Address - Fax:
Practice Address - Street 1:8401 OHIO
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6687
Practice Address - Country:US
Practice Address - Phone:219-525-4572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-22-206391106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician