Provider Demographics
NPI:1972876704
Name:WILCOX, AMY D (MA BCBA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:WILCOX
Suffix:
Gender:F
Credentials:MA BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14311 W 116TH TER APT 2006
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3850
Mailing Address - Country:US
Mailing Address - Phone:913-568-2106
Mailing Address - Fax:
Practice Address - Street 1:527 N MUR LEN RD STE B
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1218
Practice Address - Country:US
Practice Address - Phone:913-248-5510
Practice Address - Fax:913-390-0063
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-10-7851103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst