MEDICARE: MS. AMANDA ELIZABETH KLEIN LCSW, BCBA

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	9497005-3501	UT
2	106E00000X	Assistant Behavior Analyst	9497005-2507	UT
3	103K00000X	Behavior Analyst	9497005-2506	UT

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1104119619	OTHER		APPLIED BEHAVIOR ANALYST

NPI Number	:	1578951950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA ELIZABETH KLEIN LCSW, BCBA

Provider Business Mailing Address
First Line	:	6013 S REDWOOD RD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84123-5220
Country	:	US
Telephone Number	:	801-255-5131
Fax Number	:

Provider Business Practice Location Address
First Line	:	1858 W 5150 S
Second Line	:
City	:	ROY
State	:	UT
Zip	:	84067-3000
Country	:	US
Telephone Number	:	801-255-5131
Fax Number	:

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

Provider Enumeration Date	:	01/07/2015
Last Update Date	:	01/27/2023

LOTE 18 METRO OFFICE PARK , 3RD FLOOR SUITE 3000 AMERICAN HEALTH MEDICARE BUILDING
GUAYNABO, PR
00968

Practice Phone: 787-620-1919
Practice Fax: 787-620-0570

1858 W 5150 S
ROY, UT
84067-3000