Individual
AMANDA JOY POULSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
2525 S WADSWORTH BLVD, LAKEWOOD, CO 80227-3273
(720) 962-4555
Mailing address
512 N INSTITUTE ST, COLORADO SPRINGS, CO 80903-3142
(719) 310-5646
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
11829206
CO
Other
Enumeration date
06/05/2018
Last updated
06/05/2018
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