Provider Demographics
NPI:1104613850
Name:KLUCK, AMY ELIZABETH (BCBA,LBA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:KLUCK
Suffix:
Gender:
Credentials:BCBA,LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 NEW HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1312
Mailing Address - Country:US
Mailing Address - Phone:270-926-7813
Mailing Address - Fax:
Practice Address - Street 1:2401 NEW HARTFORD RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1312
Practice Address - Country:US
Practice Address - Phone:270-926-7813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY298861103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst