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NPI Code Detail

MEDICARE: AMANDA BAKER

MEDICARE: AMANDA BAKER
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst1-24-77954NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1960529OTHEREMPLOYEE ID

General Provider Information

NPI Number : 1316504624
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA BAKER
Provider Business Mailing Address
First Line : 3500 DEPAUW BLVD STE 3070
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-6135
Country : US
Telephone Number : 855-324-0885
Fax Number : 317-520-8200
Provider Business Practice Location Address
First Line : 701 FOREST POINT CIR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28273-6629
Country : US
Telephone Number : 980-375-6801
Fax Number : 317-520-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2019
Last Update Date : 01/03/2025

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Directions to “ AMANDA BAKER ” Practice Location

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