Provider Demographics
NPI:1992165096
Name:STAPLETON, JUDY (BCBA)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:STAPLETON
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 1:6627 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:CASS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48726-1262
Mailing Address - Country:US
Mailing Address - Phone:989-872-1800
Mailing Address - Fax:989-872-1801
Practice Address - Street 1:6627 ROSE ST
Practice Address - Street 2:
Practice Address - City:CASS CITY
Practice Address - State:MI
Practice Address - Zip Code:48726-1262
Practice Address - Country:US
Practice Address - Phone:989-872-1800
Practice Address - Fax:989-872-1801
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11519352103K00000X
MI68010642951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst