Basic Information
Provider Information | |||||||||
NPI: | 1669037784 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CRONIN | ||||||||
FirstName: | AMANDA | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ROWLAND | ||||||||
OtherFirstName: | AMANDA | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1875 S GENEVA RD | ||||||||
Address2: |   | ||||||||
City: | OREM | ||||||||
State: | UT | ||||||||
PostalCode: | 840582217 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8014370490 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1875 S GENEVA RD | ||||||||
Address2: |   | ||||||||
City: | OREM | ||||||||
State: | UT | ||||||||
PostalCode: | 840582217 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8014370490 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/03/2019 | ||||||||
LastUpdateDate: | 04/16/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/16/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X |   |   | N |   |   |   |   | 103K00000X | BACB497625 | UT | Y |   | Behavioral Health & Social Service Providers | Behavioral Analyst |   |
No ID Information.