Provider Demographics
NPI:1053817643
Name:MILOSEVICH, AME LYNNE
Entity Type:Individual
Prefix:
First Name:AME
Middle Name:LYNNE
Last Name:MILOSEVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8014 W REDBIRD RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-6263
Mailing Address - Country:US
Mailing Address - Phone:602-377-8861
Mailing Address - Fax:
Practice Address - Street 1:8014 W REDBIRD RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-6263
Practice Address - Country:US
Practice Address - Phone:602-377-8861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1-16-24552103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst