Provider Demographics
NPI:1497409544
Name:RANDALL, AMY J (BCBA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:RANDALL
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 1:10016 N ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-5522
Mailing Address - Country:US
Mailing Address - Phone:509-981-2147
Mailing Address - Fax:
Practice Address - Street 1:10016 N ORCHARD LN
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-5522
Practice Address - Country:US
Practice Address - Phone:509-981-2147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-21-53656OtherBEHAVIOR ANALYST CERTIFICATION BOARD