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NPI Code Detail

MEDICARE: AMANDA NICHOLE SMITH BEHAVIOR ANALYST

MEDICARE: AMANDA NICHOLE SMITH BEHAVIOR ANALYST
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
1104100000XSocial Worker
2106S00000XBehavior Technician
3103K00000XBehavior Analyst10208358-2506UT

General Provider Information

NPI Number : 1518200278
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA NICHOLE SMITH BEHAVIOR ANALYST
Provider Business Mailing Address
First Line : 515 S 700 E STE 2A
Second Line :
City : SLC
State : UT
Zip : 84102-2855
Country : US
Telephone Number : 801-808-6552
Fax Number :
Provider Business Practice Location Address
First Line : 2940 N CHURCH ST STE 204
Second Line :
City : LAYTON
State : UT
Zip : 84040-6616
Country : US
Telephone Number : 801-935-4171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2013
Last Update Date : 06/07/2021

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Directions to “ AMANDA NICHOLE SMITH BEHAVIOR ANALYST” Practice Location

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