Provider Demographics
NPI:1033539713
Name:SHELL, AMANDA JEANNE (BCABA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEANNE
Last Name:SHELL
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JEANNE
Other - Last Name:HONZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCABA
Mailing Address - Street 1:445 E DUBLIN GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3192
Mailing Address - Country:US
Mailing Address - Phone:614-832-7577
Mailing Address - Fax:614-436-8704
Practice Address - Street 1:445 E DUBLIN GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3192
Practice Address - Country:US
Practice Address - Phone:614-832-7577
Practice Address - Fax:614-436-8704
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst