Healthcare Provider Details

I. General information

NPI: 1083202329
Provider Name (Legal Business Name): AMY REPKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 JACKS RUN RD
WHITE OAK PA
15131-2549
US

IV. Provider business mailing address

16055 PERRY HWY
WEXFORD PA
15090-6885
US

V. Phone/Fax

Practice location:
  • Phone: 724-612-2791
  • Fax:
Mailing address:
  • Phone: 412-566-9697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberBH001204
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAP001131
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: