Healthcare Provider Details

I. General information

NPI: 1558281766
Provider Name (Legal Business Name): AMY MACKLIET
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 12TH ST
OGDEN UT
84404-5712
US

IV. Provider business mailing address

5145 S 1225 W
RIVERDALE UT
84405-3922
US

V. Phone/Fax

Practice location:
  • Phone: 801-335-9382
  • Fax: 385-327-9382
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number142942012506
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: