Provider Demographics
NPI:1871802991
Name:COOPER, AMY BENILDE (EDD, BCBA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BENILDE
Last Name:COOPER
Suffix:
Gender:
Credentials:EDD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 PEMBROKE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46807-2544
Mailing Address - Country:US
Mailing Address - Phone:260-479-0294
Mailing Address - Fax:
Practice Address - Street 1:10313 ABOITE CENTER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5435
Practice Address - Country:US
Practice Address - Phone:260-479-0295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst