Provider Demographics
NPI:1003100272
Name:FENWICK, AMY KATHERINE (PHD, BCBA-D, LBA)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:KATHERINE
Last Name:FENWICK
Suffix:
Gender:F
Credentials:PHD, BCBA-D, LBA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:KATHERINE
Other - Last Name:LOUKUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, BCBA-D, LBA
Mailing Address - Street 1:707 W 7TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2832
Mailing Address - Country:US
Mailing Address - Phone:509-850-1080
Mailing Address - Fax:509-461-2532
Practice Address - Street 1:707 W 7TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2832
Practice Address - Country:US
Practice Address - Phone:509-850-1080
Practice Address - Fax:509-461-2532
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-10-7400103K00000X
ORABA-B10167964103K00000X
WABA60799188103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst