Provider Demographics
NPI:1134669344
Name:GILLETTE, AMANDA (BCBA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3543 E MERIDIAN PARK LOOP STE C
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7294
Mailing Address - Country:US
Mailing Address - Phone:907-864-0099
Mailing Address - Fax:907-864-0093
Practice Address - Street 1:3543 E MERIDIAN PARK LOOP STE C
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7294
Practice Address - Country:US
Practice Address - Phone:907-864-0099
Practice Address - Fax:907-864-0093
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst