Provider Demographics
NPI:1811742653
Name:WELLENDORF, AMANDA JO (MS, BCBA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JO
Last Name:WELLENDORF
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Gender:F
Credentials:MS, BCBA
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Mailing Address - Street 1:2519 S SHIELDS ST STE 1K
Mailing Address - Street 2:BOX 567
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1855
Mailing Address - Country:US
Mailing Address - Phone:970-541-0794
Mailing Address - Fax:
Practice Address - Street 1:2519 S SHIELDS ST STE 1K
Practice Address - Street 2:BOX 567
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1855
Practice Address - Country:US
Practice Address - Phone:970-541-0794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE1-24-72500103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst