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NPI Code Detail

MEDICARE: MS. AMANDA DOHERTY CSW, TRS, CTRS

MEDICARE: MS. AMANDA DOHERTY CSW, TRS, CTRS
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
11041C0700XClinical Social Worker11991044-3502UT

General Provider Information

NPI Number : 1952195794
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMANDA DOHERTY CSW, TRS, CTRS
Provider Business Mailing Address
First Line : 1570 S 1100 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84105-2441
Country : US
Telephone Number : 385-202-4089
Fax Number :
Provider Business Practice Location Address
First Line : 1570 S 1100 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84105-2441
Country : US
Telephone Number : 385-202-4089
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2025
Last Update Date : 04/07/2025

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