Provider Demographics
NPI:1689462301
Name:MOXLEY, AMANDA JOANNE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOANNE
Last Name:MOXLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7820 S LA BARRANCA CT
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5613
Mailing Address - Country:US
Mailing Address - Phone:801-599-9194
Mailing Address - Fax:801-599-9194
Practice Address - Street 1:7820 S LA BARRANCA CT
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-5613
Practice Address - Country:US
Practice Address - Phone:801-599-9194
Practice Address - Fax:801-599-9194
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5740771-3501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical