Provider Demographics
NPI:1376107094
Name:ROYER, AMANDA LEE (RBT, QASP-S)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:ROYER
Suffix:
Gender:F
Credentials:RBT, QASP-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21904 NW CASCADIAN ST
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-9255
Mailing Address - Country:US
Mailing Address - Phone:858-539-5143
Mailing Address - Fax:
Practice Address - Street 1:837 CALLAHAN DR STE C
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3368
Practice Address - Country:US
Practice Address - Phone:360-220-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19-85176106S00000X
WA12993106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA19-85176OtherRBT NUMBER