Individual
AMANDA LAIQ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
227 W GRIMES LN, BLOOMINGTON, IN 47403-3015
(812) 322-0313
(812) 610-1814
Mailing address
PO BOX 668, BLOOMINGTON, IN 47402-0668
(812) 322-0313
(812) 610-1814
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-145839
IN
Other
Enumeration date
12/16/2020
Last updated
12/16/2020
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