Provider Demographics
NPI:1154837805
Name:CRUDUP, AMBER NICOLE (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:CRUDUP
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 N 6TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-5314
Mailing Address - Country:US
Mailing Address - Phone:217-295-2491
Mailing Address - Fax:
Practice Address - Street 1:614 N 6TH ST STE B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5314
Practice Address - Country:US
Practice Address - Phone:217-295-2491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician