Healthcare Provider Details

I. General information

NPI: 1245142157
Provider Name (Legal Business Name): AMY M HART BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 COFFEEN AVE STE 3
SHERIDAN WY
82801-5777
US

IV. Provider business mailing address

1309 COFFEEN AVE STE 3
SHERIDAN WY
82801-5777
US

V. Phone/Fax

Practice location:
  • Phone: 307-201-2532
  • Fax: 307-200-2465
Mailing address:
  • Phone: 307-201-2532
  • Fax: 307-200-2465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA-111
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: