Most Relevant Information
Provider Data
| NPI Number: | 1003253394 |
| Provider Name: | STEPHANIE BROCKMAN BCBA |
| Entity Type: | Individual |
| Taxonomy Code: | 103K00000X |
| Specialty: | Behavior Analyst |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/28/2013 |
| Last Updated: | 03/14/2017 |
Provider Practice Location
300 N 18TH ST
PHOENIX
AZ
850064103
Practice Location Phone/Fax
| Phone: | 6023408717 |
| Fax: |
Provider Mailing Location
300 N 18TH ST
PHOENIX
AZ
850064103
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |