Healthcare Provider Details

I. General information

NPI: 1235543232
Provider Name (Legal Business Name): AMBER MARTINSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOOTHILL DR 111 BH
SALT LAKE CITY UT
84148-0001
US

IV. Provider business mailing address

1004 W TUSCANY VIEW RD A27
MIDVALE UT
84047-4808
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax:
Mailing address:
  • Phone: 207-590-3918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8834854-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: