Provider Demographics
NPI:1114316270
Name:ONDRAK, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ONDRAK
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 1:10786 GROVE LN
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-2252
Mailing Address - Country:US
Mailing Address - Phone:720-938-2854
Mailing Address - Fax:
Practice Address - Street 1:10786 GROVE LN
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-2252
Practice Address - Country:US
Practice Address - Phone:720-938-2854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst