Individual
AMANDA LEA MIZER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
3048 S CLIFTON AVE STE 112, SPRINGFIELD, MO 65807-6045
(417) 818-5784
(417) 315-8621
Mailing address
3048 S CLIFTON AVE STE 112, SPRINGFIELD, MO 65807-6045
(417) 818-5784
(417) 315-8621
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-35331
MO
103K00000X
Behavior Analyst
1-19-35331
—
103K00000X
Behavior Analyst
8067
TX
106S00000X
Behavior Technician
8067
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8067
QASP
TX
Enumeration date
06/28/2018
Last updated
02/22/2022
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