MEDICARE: AMANDA BECKSTEAD

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1588161947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA BECKSTEAD

Provider Business Mailing Address
First Line	:	3214 BROKEN ROCK WAY
Second Line	:
City	:	WASHINGTON
State	:	UT
Zip	:	84780-7901
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3214 BROKEN ROCK WAY
Second Line	:
City	:	WASHINGTON
State	:	UT
Zip	:	84780-7901
Country	:	US
Telephone Number	:	435-770-3770
Fax Number	:

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

Provider Enumeration Date	:	04/11/2018
Last Update Date	:	04/11/2018

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Directions to “ AMANDA BECKSTEAD ” Practice Location

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