Provider Demographics
NPI:1487294831
Name:KROCZAK, AMY (BCBA)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:KROCZAK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:DART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105B 182ND PL SW
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6204
Mailing Address - Country:US
Mailing Address - Phone:425-736-2816
Mailing Address - Fax:
Practice Address - Street 1:105B 182ND PL SW
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-6204
Practice Address - Country:US
Practice Address - Phone:425-736-2816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-18-32892OtherBACB
WABA60973206OtherWASHINGTON STATE DEPARTMENT OF HEALTH