Provider Demographics
NPI:1518299593
Name:PHILLIPS, AMBER MATHIESEN (MS)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MATHIESEN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 N MEDICAL DR
Mailing Address - Street 2:ROOM 2185
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-1204
Mailing Address - Country:US
Mailing Address - Phone:801-915-7459
Mailing Address - Fax:
Practice Address - Street 1:50 NORTH MEDICAL DRIVE
Practice Address - Street 2:ROOM 2185
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84132-1204
Practice Address - Country:US
Practice Address - Phone:801-915-7459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS