Individual
MRS. AMANDA REA BIRD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, BCBA
Contact information
Practice address
5415 129TH PL, APT 4, CRESTWOOD, IL 60445
(708) 224-5581
Mailing address
5415 129TH PL APT 4, CRESTWOOD, IL 60418-1282
(708) 224-5581
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-13-14030
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-13-14030
BEHAVIOR ANALYST CERTIFICATION BOARD
—
Enumeration date
12/07/2010
Last updated
08/28/2018
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