Healthcare Provider Details

I. General information

NPI: 1891196986
Provider Name (Legal Business Name): ALEXA ALLRED ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E FOOTHILL BLVD STE 102
ARCADIA CA
91006
US

IV. Provider business mailing address

150 E 700 S
SALT LAKE CITY UT
84111-3806
US

V. Phone/Fax

Practice location:
  • Phone: 626-701-4249
  • Fax:
Mailing address:
  • Phone: 801-364-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number79472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: