MEDICARE: AMANDA VERONICA VALE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BEH-000877	AZ

General Provider Information

NPI Number	:	1225511165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA VERONICA VALE

Provider Business Mailing Address
First Line	:	2301 E YEAGER DR STE 14
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85286-1578
Country	:	US
Telephone Number	:	602-606-2237
Fax Number	:	844-475-2307

Provider Business Practice Location Address
First Line	:	15220 S 50TH ST STE 103
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-9132
Country	:	US
Telephone Number	:	480-795-7165
Fax Number	:	844-475-2307

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2018
Last Update Date	:	06/29/2022

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Directions to “ AMANDA VERONICA VALE ” Practice Location

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