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NPI Code Detail

MEDICARE: AMANDA CROSLAND

MEDICARE: AMANDA CROSLAND
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker13074528-3502UT

General Provider Information

NPI Number : 1154943306
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA CROSLAND
Provider Business Mailing Address
First Line : 95 GOLF COURSE RD STE 105
Second Line :
City : LOGAN
State : UT
Zip : 84321-5990
Country : US
Telephone Number : 435-915-6398
Fax Number :
Provider Business Practice Location Address
First Line : 95 GOLF COURSE RD STE 105
Second Line :
City : LOGAN
State : UT
Zip : 84321-5990
Country : US
Telephone Number : 435-915-6398
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2020
Last Update Date : 03/13/2024

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Directions to “ AMANDA CROSLAND ” Practice Location

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