Healthcare Provider Details

I. General information

NPI: 1407764012
Provider Name (Legal Business Name): AMELIE JESSIE MAYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17947 LAPIS CT
MONUMENT CO
80132-7801
US

IV. Provider business mailing address

272 ELLERS GRV
COLORADO SPRINGS CO
80916-1661
US

V. Phone/Fax

Practice location:
  • Phone: 440-409-5367
  • Fax:
Mailing address:
  • Phone: 951-539-2263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-533562
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: