Provider Demographics
NPI:1285007104
Name:MEYER, AMANDA FAYE (MS, BCBA, COBA)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:FAYE
Last Name:MEYER
Suffix:
Gender:F
Credentials:MS, BCBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 BAIRD AVE
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-2217
Mailing Address - Country:US
Mailing Address - Phone:330-329-8211
Mailing Address - Fax:
Practice Address - Street 1:2132 CASE PKWY
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-4300
Practice Address - Country:US
Practice Address - Phone:330-888-9369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-14-16380103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst