NPIMap

Individual provider Active NPI

Amanda Carlson, BCBA

  • Behavior Analyst
  • Janesville, WI
National Provider Identifier
1730890856
Registry record updated Dec 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1051 Issued in WI
Practice address
211 N Parker Dr
Janesville, WI 53545-3021
Phone
(608) 662-9327
NPI assigned
Dec 9, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 1051 WI Primary

Addresses

Primary practice location

211 N Parker Dr
Janesville, WI 53545-3021

Mailing address

6225 Smith Ave Ste 1001a
Baltimore, MD 21209-3626

Other names 1

  • Amanda Guetzkow Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
1051WIMDGenetic Counselor (M.S.)

Practice roles

OrganizationSpecialtyStatusNew patients
Autism Spectrum Therapies, LLC Behavior Analyst Past Accepting new patients
Autism Spectrum Therapies of Delaware, LLC Behavior Analyst Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1670544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670544000000",
    "number": "1730890856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6225 SMITH AVE STE 1001A",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212093626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 N PARKER DR",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535453021",
            "telephone_number": "608-662-9327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "AMANDA",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-09",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "WI",
            "license": "1051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "GUETZKOW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Janesville, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.