Provider Demographics
NPI:1083631436
Name:REEDER, AMY FILLMORE (RD)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:FILLMORE
Last Name:REEDER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 BROWNING AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2307
Mailing Address - Country:US
Mailing Address - Phone:801-746-0776
Mailing Address - Fax:801-746-0775
Practice Address - Street 1:807 E SOUTH TEMPLE
Practice Address - Street 2:STE 101
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1339
Practice Address - Country:US
Practice Address - Phone:801-746-0776
Practice Address - Fax:801-746-0775
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT371273-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered