Healthcare Provider Details

I. General information

NPI: 1518200278
Provider Name (Legal Business Name): AMANDA NICHOLE SMITH BEHAVIOR ANALYST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA CAMPBELL

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 S WEST TEMPLE
SALT LAKE CITY UT
84115-1816
US

IV. Provider business mailing address

1776 S WEST TEMPLE
SALT LAKE CITY UT
84115-1816
US

V. Phone/Fax

Practice location:
  • Phone: 801-214-1115
  • Fax:
Mailing address:
  • Phone: 801-214-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number10208358-2506
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: