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General NPI Number Information
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NPI Number | 1972093789
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL ASSESSMENT & INTERVENTION RESOURCES, PC
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Dates
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Enumeration Date | 05/16/2018
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Last Update Date | 05/16/2018
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Provider Practice Location Address
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Address Line | 922 W BAXTER DR STE 260
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-8626
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Country | US
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Telephone | 801-822-9542
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Fax |
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Provider Business Mailing Address
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Address Line | 922 W BAXTER DR STE 260
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-8626
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Country | US
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Telephone | 801-822-9542
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. AMANDA RAPACZ
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Credential | PSY.D.
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Telephone | 801-822-9542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 10160877-0144
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License Number State | UT
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