Healthcare Provider Details

I. General information

NPI: 1699477091
Provider Name (Legal Business Name): AMANDA JO THORPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 26TH ST STE 100
OGDEN UT
84401-2459
US

IV. Provider business mailing address

533 26TH ST STE 100
OGDEN UT
84401-2459
US

V. Phone/Fax

Practice location:
  • Phone: 801-920-2598
  • Fax:
Mailing address:
  • Phone: 801-920-2598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12952614-3502
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12952614-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: