Russell, Amanda

Russell, Amanda is an individual health care provider with primary practice located at 1578 W 1700 S #200, Slc UT 84104-3470. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Russell, Amanda can be contacted via phone (801) 972-2711.

Contact Information

Primary practice address
1578 W 1700 S #200 Slc UT 84104-3470
Phone: (801) 972-2711
Fax: (801) 972-2709
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 5922570-3502 Utah
Behavioral Health & Social Service Providers / Clinical 1041C0700X 5922570-3501 Utah

Profile Details

NPI number 1699730952
LBN Legal business name Russell, Amanda
Credentials Certified Social Worker (CSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 19th, 2006
Last updated Feb 25th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699730952 NPPES
Utah MEDICAID 788007788049

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