Healthcare Provider Details

I. General information

NPI: 1548699846
Provider Name (Legal Business Name): AMY MICHELLE GUIGNON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 FOREST PARK AVE SUITE 2600
SAINT LOUIS MO
63108-2212
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8134
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-1700
  • Fax: 314-286-1799
Mailing address:
  • Phone: 314-286-1700
  • Fax: 314-286-1799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2013017370
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: