Provider Demographics
NPI:1649768177
Name:LACHER, AMY MARIE (BCBA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:LACHER
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 1:1975 W CHURCH RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-2102
Mailing Address - Country:US
Mailing Address - Phone:907-414-9554
Mailing Address - Fax:
Practice Address - Street 1:1975 W CHURCH RIDGE DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-2102
Practice Address - Country:US
Practice Address - Phone:907-414-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK153613106E00000X
AK106S00000X
AK1-19-40360103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician