Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-10-7242 | UT |
NPI | 1013229673 |
---|---|
Provider Name | Ms. Amy Marie Peters |
First Address | Mountain Green, UT 84050-6800 |
Second Address | Mountain Green, UT 84050-6800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2010 |
Last Update Date | 11/07/2010 |