Healthcare Provider Details

I. General information

NPI: 1780894675
Provider Name (Legal Business Name): AMANDA L FERGUSON MT-BC, NMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA BURKART

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 N 3RD ST SUITE 1000
PHOENIX AZ
85004-1130
US

IV. Provider business mailing address

16410 S 12TH ST # 109
PHOENIX AZ
85048-4001
US

V. Phone/Fax

Practice location:
  • Phone: 602-840-6410
  • Fax: 602-840-6431
Mailing address:
  • Phone: 602-478-0287
  • Fax: 480-659-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: