Provider Demographics
NPI:1851737332
Name:GALLOWAY, AMANDA (SSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 E NEWSOME PARK LN
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-4972
Mailing Address - Country:US
Mailing Address - Phone:801-588-9129
Mailing Address - Fax:
Practice Address - Street 1:361 E NEWSOME PARK LN
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-4972
Practice Address - Country:US
Practice Address - Phone:801-588-9129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6953390-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health