=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558281766
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY MACKLIET
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2026
-----------------------------------------------------
Last Update Date | 07/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 349 12TH ST
-----------------------------------------------------
City | OGDEN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84404-5712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-335-9382
-----------------------------------------------------
Fax | 385-327-9382
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5145 S 1225 W
-----------------------------------------------------
City | RIVERDALE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84405-3922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 142942012506
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------