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General NPI Number Information
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NPI Number | 1497493324
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Entity Type | Individual
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Provider Name | AMIE ROSE BOMBER
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Gender | Female
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Dates
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Enumeration Date | 05/20/2022
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Last Update Date | 05/20/2022
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Provider Practice Location Address
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Address Line | 500 AMS CT
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City | GREEN BAY
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State | WI
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Zip | 54313-9704
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Country | US
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Telephone | 920-544-4970
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Fax |
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Provider Business Mailing Address
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Address Line | 1040 MORAINE WAY APT 1
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City | GREEN BAY
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State | WI
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Zip | 54303-9420
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 515-140
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License Number State | WI
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