Healthcare Provider Details

I. General information

NPI: 1013229673
Provider Name (Legal Business Name): AMY MARIE PETERS M.ED., CCC-SLP, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2010
Last Update Date: 07/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3986 LILAC LN
MOUNTAIN GREEN UT
84050-6800
US

IV. Provider business mailing address

3986 LILAC LN
MOUNTAIN GREEN UT
84050-6800
US

V. Phone/Fax

Practice location:
  • Phone: 801-876-3949
  • Fax:
Mailing address:
  • Phone: 801-876-3949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number09138092
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-10-7242
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: