Healthcare Provider Details

I. General information

NPI: 1740911999
Provider Name (Legal Business Name): JESSICA ELDER ALLRED LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 W 500 S STE 440
BOUNTIFUL UT
84010-8296
US

IV. Provider business mailing address

563 W 500 S STE 440
BOUNTIFUL UT
84010-8296
US

V. Phone/Fax

Practice location:
  • Phone: 801-679-4512
  • Fax:
Mailing address:
  • Phone: 801-872-3234
  • Fax: 801-207-8313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JESSICA ALLRED
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 801-856-8897