Basic Information
Provider Information
NPI: 1669037545
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STEAD
FirstName: EMILY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8354 E NORTHFIELD BLVD UNIT 3700
Address2:  
City: DENVER
State: CO
PostalCode: 802383135
CountryCode: US
TelephoneNumber: 7209613764
FaxNumber:  
Practice Location
Address1: 8354 E NORTHFIELD BLVD UNIT 3700
Address2:  
City: DENVER
State: CO
PostalCode: 802383135
CountryCode: US
TelephoneNumber: 7209613764
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/06/2019
LastUpdateDate: 02/16/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/16/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103K00000X  Y Behavioral Health & Social Service ProvidersBehavioral Analyst 

No ID Information.


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