Healthcare Provider Details

I. General information

NPI: 1518603125
Provider Name (Legal Business Name): AMANDA KAZEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 BLANDING ST
COLUMBIA SC
29201-2906
US

IV. Provider business mailing address

1505 BLANDING ST
COLUMBIA SC
29201-2906
US

V. Phone/Fax

Practice location:
  • Phone: 803-929-0011
  • Fax: 803-569-1054
Mailing address:
  • Phone: 803-929-0011
  • Fax: 803-569-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: