Provider Demographics
NPI:1235806902
Name:LOPEZ, STEPHANIE ELLEN (MA, BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ELLEN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:ELLEN
Other - Last Name:FODOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2080 WOODDALE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2920
Mailing Address - Country:US
Mailing Address - Phone:612-201-2468
Mailing Address - Fax:
Practice Address - Street 1:2080 WOODDALE DR STE 200
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2920
Practice Address - Country:US
Practice Address - Phone:612-201-2468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MNLBA0528103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician