Healthcare Provider Details

I. General information

NPI: 1578951950
Provider Name (Legal Business Name): AMANDA ELIZABETH KLEIN LCSW, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1858 W 5150 S
ROY UT
84067-3000
US

IV. Provider business mailing address

6013 S REDWOOD RD
SALT LAKE CITY UT
84123-5220
US

V. Phone/Fax

Practice location:
  • Phone: 801-255-5131
  • Fax:
Mailing address:
  • Phone: 801-255-5131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9497005-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number9497005-2507
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number9497005-2506
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1104119619
Identifier TypeOTHER
Identifier State
Identifier IssuerAPPLIED BEHAVIOR ANALYST

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: