| NPI | 1770989188 |
|---|---|
| Former Name | AMANDA NICOLE JEANE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MS 220059) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 103K00000X Behavior Analyst (Licence: AL 2023-054) | |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2024-05-17 |