Provider Demographics
NPI:1346607025
Name:COLYER, AUDREY MARIE (MA, BCBA, COBA)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:MARIE
Last Name:COLYER
Suffix:
Gender:F
Credentials:MA, BCBA, COBA
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:VANDEGRIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5180 CEDAR VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-3701
Mailing Address - Country:US
Mailing Address - Phone:513-638-0303
Mailing Address - Fax:
Practice Address - Street 1:5180 CEDAR VILLAGE DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-3701
Practice Address - Country:US
Practice Address - Phone:513-638-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOBA.231103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1-15-18009OtherBACB CERTIFICATE