MEDICARE: MRS. AMANDA LEANN MCPHERSON CUTLER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	10458774-3501	UT
2	1041C0700X	Clinical Social Worker	LCSW-33360	ID

General Provider Information

NPI Number	:	1285822213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA LEANN MCPHERSON CUTLER LCSW

Provider Business Mailing Address
First Line	:	1336 S 1100 E STE 100
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2421
Country	:	US
Telephone Number	:	208-918-1199
Fax Number	:

Provider Business Practice Location Address
First Line	:	1336 S 1100 E STE 100
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2421
Country	:	US
Telephone Number	:	208-918-1199
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	09/22/2023

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