Healthcare Provider Details

I. General information

NPI: 1750035622
Provider Name (Legal Business Name): ALYSSA MARIE POLITO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 W LEVOY DR STE 108
TAYLORSVILLE UT
84123-2599
US

IV. Provider business mailing address

7070 S UNION PARK AVE STE 150
MIDVALE UT
84047-6043
US

V. Phone/Fax

Practice location:
  • Phone: 801-405-7450
  • Fax: 385-446-2650
Mailing address:
  • Phone: 801-405-7450
  • Fax: 385-446-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: