Provider Demographics
NPI:1831786243
Name:SPEECE, ANDREA DAWN (BCBA, COBA)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:DAWN
Last Name:SPEECE
Suffix:
Gender:F
Credentials:BCBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 S DUCK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:44451-9736
Mailing Address - Country:US
Mailing Address - Phone:330-718-2693
Mailing Address - Fax:
Practice Address - Street 1:15445 CHARDON WINDSOR RD
Practice Address - Street 2:
Practice Address - City:HUNTSBURG
Practice Address - State:OH
Practice Address - Zip Code:44046-8728
Practice Address - Country:US
Practice Address - Phone:440-313-8636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH225103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst