Individual provider Active NPI

Amanda Hanson Stansfield, LCSW

  • Clinical Social Worker
  • Provo, UT
National Provider Identifier
1104918424
Registry record updated May 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
5276467-3501 Issued in UT
Practice address
750 N Freedom Blvd
Provo, UT 84601-1677
Phone
(801) 373-4760
NPI assigned
Sep 28, 2006
Last updated
May 10, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 5276467-3503 UT
Clinical Social Worker 1041C0700X 5276467-3501 UT Primary

Addresses

Primary practice location

750 N Freedom Blvd
Provo, UT 84601-1677

Mailing address

750 N Freedom Blvd
Provo, UT 84601-1677
Phone (801) 373-4760

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180904003197 UT Practitioner - Clinical Social Worker 8224388749 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

750 N Freedom Blvd
Provo, UT 84601-1677
Phone (801) 373-4760

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5276467-3503UTMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Wasatch Behavioral Health Special Service District CurrentSince Aug 22, 2018 Accepting new patients
Wasatch Behavioral Health Special Service District CurrentSince Aug 22, 2018 Accepting new patients
Chrysalis Utah, LLC CurrentSince Aug 1, 2018 Accepting new patients

Locations

1443 W 800 N
Ste 103
Orem, UT 84057
Phone (801) 604-1455

1185 E 300 N
Provo, UT 84606
Phone (801) 373-2215

1507 S 180 E
Provo, UT 84606
Phone (801) 426-6661

750 N Freedom Blvd
Provo, UT 84601
Phone (801) 373-0639

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683676800000",
    "number": "1104918424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 N FREEDOM BLVD",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846011677",
            "telephone_number": "801-373-4760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 N FREEDOM BLVD",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846011677",
            "telephone_number": "801-373-4760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANSFIELD",
        "first_name": "AMANDA",
        "middle_name": "HANSON",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2023-05-10",
        "certification_date": "2023-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "UT",
            "license": "5276467-3503",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "5276467-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.