Provider Demographics
NPI:1205679289
Name:RUDD, AMY CLAIRE (MSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CLAIRE
Last Name:RUDD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10942 S PADDLE BOARD WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-1319
Mailing Address - Country:US
Mailing Address - Phone:801-839-9044
Mailing Address - Fax:
Practice Address - Street 1:151 E 5600 S STE 308
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8102
Practice Address - Country:US
Practice Address - Phone:801-262-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7130553-35021041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical