Provider Demographics
NPI:1003657263
Name:AMES, IYONA GISELLE
Entity type:Individual
Prefix:
First Name:IYONA
Middle Name:GISELLE
Last Name:AMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1998 SE CARVALHO ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-4543
Mailing Address - Country:US
Mailing Address - Phone:772-773-0445
Mailing Address - Fax:
Practice Address - Street 1:1340 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-7408
Practice Address - Country:US
Practice Address - Phone:561-335-9061
Practice Address - Fax:561-855-7587
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician