Provider Demographics
NPI:1841756590
Name:GARRETT-BAKER, AMANDA SUSAN (BCBA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUSAN
Last Name:GARRETT-BAKER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11731 S CANBERRA DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-5694
Mailing Address - Country:US
Mailing Address - Phone:325-642-8586
Mailing Address - Fax:801-758-3633
Practice Address - Street 1:11731 S CANBERRA DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-5694
Practice Address - Country:US
Practice Address - Phone:325-642-8586
Practice Address - Fax:801-758-3633
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11795525-2506103K00000X
TX1-19-36762103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst