MEDICARE: AMANDA JEAN PRICE BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1467744995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA JEAN PRICE BCBA

Provider Business Mailing Address
First Line	:	753 GENEVA PKWY N UNIT 2
Second Line	:
City	:	LAKE GENEVA
State	:	WI
Zip	:	53147-4579
Country	:	US
Telephone Number	:	920-857-9041
Fax Number	:	920-857-3366

Provider Business Practice Location Address
First Line	:	753 GENEVA PKWY N UNIT 2
Second Line	:
City	:	LAKE GENEVA
State	:	WI
Zip	:	53147-4579
Country	:	US
Telephone Number	:	920-857-9041
Fax Number	:	920-857-3366

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2011
Last Update Date	:	08/21/2025

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Directions to “ AMANDA JEAN PRICE BCBA” Practice Location

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