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NPI Code Detail

MEDICARE: AMANDA NIEMERG M.S., BCBA

MEDICARE: AMANDA NIEMERG M.S., BCBA
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1982000279
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA NIEMERG M.S., BCBA
Provider Business Mailing Address
First Line : 2560 METRO BLVD
Second Line :
City : MARYLAND HEIGHTS
State : MO
Zip : 63043-2417
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8609 W BRYN MAWR AVE STE 204
Second Line :
City : CHICAGO
State : IL
Zip : 60631-3524
Country : US
Telephone Number : 773-726-1416
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2014
Last Update Date : 05/05/2021

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