Healthcare Provider Details

I. General information

NPI: 1124950951
Provider Name (Legal Business Name): AMANDA WALTERS MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3273 W COUNTRY BLUFF RD
SOUTH JORDAN UT
84095-8061
US

IV. Provider business mailing address

3273 W COUNTRY BLUFF RD
SOUTH JORDAN UT
84095-8061
US

V. Phone/Fax

Practice location:
  • Phone: 801-718-0770
  • Fax:
Mailing address:
  • Phone: 801-718-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5505485-4102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: