Individual
AMANDA LEIGH EVANICKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4101 NW 22ND ST, CAPE CORAL, FL 33993-3442
(561) 573-7902
Mailing address
4101 NW 22ND ST, CAPE CORAL, FL 33993-3442
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
106S00000X
FL
106S00000X
Behavior Technician
Primary
19-90854
FL
Other
Enumeration date
08/23/2019
Last updated
08/23/2019
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