Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | 1-08-4175 | PA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PS016390 | PA |
Y | 103TS0200X | School Psychologist | PS016390 | PA |
NPI | 1053543876 |
---|---|
Provider Name | Amanda L Lannie |
First Address | King Of Prussia, PA 19406-2786 |
Second Address | King Of Prussia, PA 19406-2786 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2009 |
Last Update Date | 12/08/2009 |