Individual
AMANDA RAY MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1020 S MAIN ST, SALT LAKE CITY, UT 84101-3176
(888) 949-4864
Mailing address
4460 S HIGHLAND DR STE 120, SALT LAKE CITY, UT 84124-3550
(888) 949-4864
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
104100000X
Social Worker
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000055266
MEDICARE PIN
UT
01
—
260022408
RAILROAD MEDICARE
UT
05
—
8760003008007
—
UT
Enumeration date
04/17/2019
Last updated
02/09/2023
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