Provider Demographics
NPI:1336788967
Name:SIAMRO, AMANDA KAYE (BA, RBT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAYE
Last Name:SIAMRO
Suffix:
Gender:F
Credentials:BA, RBT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:KAYE
Other - Last Name:SIAMRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6085 WATER ST APT 2472
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-0140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8875 SYNERGY DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6503
Practice Address - Country:US
Practice Address - Phone:972-872-8454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-19-88841106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician