Provider Demographics
NPI:1932710837
Name:BLUME, AMANDA KATHLEEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:KATHLEEN
Last Name:BLUME
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 E 10140 S
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4486
Mailing Address - Country:US
Mailing Address - Phone:417-379-4481
Mailing Address - Fax:
Practice Address - Street 1:84 W 4800 S STE 100
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-3781
Practice Address - Country:US
Practice Address - Phone:801-266-1499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health