Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-19-39771 | |
N | 106E00000X | Assistant Behavior Analyst | ||
N | 106S00000X | Behavior Technician |
NPI | 1033647540 |
---|---|
Provider Name | Mrs. Amanda Marie Swanson |
First Address | Carmel, CA 93923-8516 |
Second Address | Cameron, NC 28326-9379 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2017 |
Last Update Date | 22/12/2019 |