Most Relevant Information
Provider Data
| NPI Number: | 1003048539 |
| Provider Name: | STACEY OSMON BCBA |
| Entity Type: | Individual |
| Taxonomy Code: | 103K00000X |
| Specialty: | Behavior Analyst |
| License Number: | 1-04-1846 |
Most Important Dates
| Enumeration Date: | 08/18/2009 |
| Last Updated: | 07/24/2019 |
Provider Practice Location
2780 VERANDAH VUE WAY
LAKELAND
FL
338126392
Practice Location Phone/Fax
| Phone: | 8636192809 |
| Fax: |
Provider Mailing Location
PO BOX 2112
LAKELAND
FL
338062112
Provider Mailing Phone/Fax
| Phone: | 8636192809 |
| Fax: | 8636449590 |