Individual
AMANDA POWELL KELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1950 S SUNWEST LANE SUITE 200, SAN BERNARDINO, CA 92418-1970
(909) 252-4017
Mailing address
1950 S SUNWEST LANE SUITE 200, SAN BERNARDINO, CA 92418-1970
(909) 252-4017
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396085718
—
UT
Enumeration date
07/14/2022
Last updated
05/11/2024
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