MEDICARE: AMBER MATHIESEN PHILLIPS MS

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
1	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1518299593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER MATHIESEN PHILLIPS MS

Provider Business Mailing Address
First Line	:	50 N MEDICAL DR
Second Line	:	ROOM 2185
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-1204
Country	:	US
Telephone Number	:	801-915-7459
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 NORTH MEDICAL DRIVE
Second Line	:	ROOM 2185
City	:	SLC
State	:	UT
Zip	:	84132-1204
Country	:	US
Telephone Number	:	801-915-7459
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2010
Last Update Date	:	11/06/2020

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