Provider Demographics
NPI:1447048913
Name:DYMEN, AMANDA IRENE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:IRENE
Last Name:DYMEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N BIG TREE LN
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-1110
Mailing Address - Country:US
Mailing Address - Phone:208-546-1576
Mailing Address - Fax:
Practice Address - Street 1:1300 N BIG TREE LN
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-1110
Practice Address - Country:US
Practice Address - Phone:208-546-1576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician