Provider Demographics
NPI:1427308832
Name:AZON, AMANDA ANN (BCBA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ANN
Last Name:AZON
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5S438 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2829
Mailing Address - Country:US
Mailing Address - Phone:630-886-1881
Mailing Address - Fax:
Practice Address - Street 1:5S438 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2829
Practice Address - Country:US
Practice Address - Phone:630-886-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-9237103K00000X
IL152.001019103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst