Andrew Crossman, BCBA
Individual provider Active NPI Behavior Analyst · Ammon, ID
NPI 1578034674 · NPPES record last updated Dec 16, 2018
Key facts
- NPI
- 1578034674
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- License
- 1-18-32244 (ID)
- Practice address
- 1560 Midway Dr
Ammon, ID 83406-6912 - Phone
- (208) 522-1217
- NPI assigned
- Dec 16, 2018
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-18-32244 | ID | Yes |
Addresses
Primary practice location
1560 Midway Dr
Ammon, ID 83406-6912
Mailing address
1570 Midway Dr
Ammon, ID 83406-6912
Phone (208) 709-0537
Other practice location 1
265 E 4th N
Rexburg, ID 83440-1659
Phone (208) 356-4836
Other practice location 2
1177 Call Place
Pocatello, ID 83201
Phone (208) 235-1334
Other providers in Ammon, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 16, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.