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General NPI Number Information
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NPI Number | 1730635038
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Entity Type | Individual
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Provider Name | AMANDA WILD EDD, BCBA, LBA, LABA
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Gender | Female
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 12/07/2025
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Provider Practice Location Address
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Address Line | 12531 CLIPPER DR STE 201
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2355
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Country | US
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Telephone | 571-398-0428
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Fax |
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Provider Business Mailing Address
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Address Line | 182 BROOKSIDE DR
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-2007
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Country | US
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Telephone | 401-742-3977
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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 | 0133003768
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | LBA00023
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License Number State | RI
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