Provider Demographics
NPI:1245426865
Name:WIECH, AMY DS (BCBA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:DS
Last Name:WIECH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:DANIELLE
Other - Last Name:FARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:99-870 IWAENA ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3278
Mailing Address - Country:US
Mailing Address - Phone:808-277-7736
Mailing Address - Fax:
Practice Address - Street 1:99-870 IWAENA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3278
Practice Address - Country:US
Practice Address - Phone:808-277-7736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIBA-34103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst