Provider Demographics
NPI:1427403054
Name:WALTER, AMY (BCBA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WALTER
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 1:1661 BOYSON SQUARE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2344
Mailing Address - Country:US
Mailing Address - Phone:319-221-7376
Mailing Address - Fax:515-957-3380
Practice Address - Street 1:1661 BOYSON SQUARE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2344
Practice Address - Country:US
Practice Address - Phone:319-221-7376
Practice Address - Fax:515-957-3380
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-15-19875103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst