Healthcare Provider Details

I. General information

NPI: 1417875881
Provider Name (Legal Business Name): ALYSSA ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 S MAIN ST
BOUNTIFUL UT
84010-6265
US

IV. Provider business mailing address

145 S MAIN ST
BOUNTIFUL UT
84010-6265
US

V. Phone/Fax

Practice location:
  • Phone: 801-934-4946
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: