Healthcare Provider Details

I. General information

NPI: 1861386369
Provider Name (Legal Business Name): AMBER DETHLEFS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER SHUSTER PH.D.

II. Dates (important events)

Enumeration Date: 06/07/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6787 S REDWOOD RD STE 5
WEST JORDAN UT
84084-2404
US

IV. Provider business mailing address

455 S WOOD STREAM RD
AMERICAN FORK UT
84003-4303
US

V. Phone/Fax

Practice location:
  • Phone: 801-839-5360
  • Fax:
Mailing address:
  • Phone: 330-635-7442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number14299994-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: