Provider Demographics
NPI:1386936037
Name:BOSCHERT, ANDREA M (BCBA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:BOSCHERT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:M
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 SHERIFF DIERKER CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2468
Mailing Address - Country:US
Mailing Address - Phone:636-978-7885
Mailing Address - Fax:636-978-7885
Practice Address - Street 1:105 SHERIFF DIERKER CT
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2468
Practice Address - Country:US
Practice Address - Phone:636-978-4951
Practice Address - Fax:636-978-7885
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011008957103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2011008957OtherLICENSE
MO0-10-3821OtherCERTIFICATION