Healthcare Provider Details

I. General information

NPI: 1700638053
Provider Name (Legal Business Name): ALLISON MCLEOD SPILLERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON RENEE MCLEOD

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3422 CYPRESS ST
WEST MONROE LA
71291-7310
US

IV. Provider business mailing address

530 S WAKARA WAY
SALT LAKE CITY UT
84108-1213
US

V. Phone/Fax

Practice location:
  • Phone: 318-497-4007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7728
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: