Healthcare Provider Details

I. General information

NPI: 1760313068
Provider Name (Legal Business Name): AMANDA FAE HOTTINGER ACMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 W SOUTH JORDAN PKWY STE B
SOUTH JORDAN UT
84095-5505
US

IV. Provider business mailing address

1108 W SOUTH JORDAN PKWY STE B
SOUTH JORDAN UT
84095-5505
US

V. Phone/Fax

Practice location:
  • Phone: 385-215-9084
  • Fax:
Mailing address:
  • Phone: 385-215-9084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14289675-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: