Healthcare Provider Details

I. General information

NPI: 1154837144
Provider Name (Legal Business Name): JON BAMBA BCBA, LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4741 COLONEL ASHTON PL
UPPER MARLBORO MD
20772-2881
US

IV. Provider business mailing address

1314 S. GRAND BLVD STE 2 PMB 238
SPOKANE WA
99202
US

V. Phone/Fax

Practice location:
  • Phone: 808-300-9059
  • Fax:
Mailing address:
  • Phone: 808-300-9059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA2225
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: