Healthcare Provider Details

I. General information

NPI: 1891426417
Provider Name (Legal Business Name): ALEXSIS ALLRED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date: 11/14/2025
Reactivation Date: 12/04/2025

III. Provider practice location address

811 N HARRISVILLE RD
HARRISVILLE UT
84404-3537
US

IV. Provider business mailing address

811 N HARRISVILLE RD
HARRISVILLE UT
84404-3537
US

V. Phone/Fax

Practice location:
  • Phone: 801-399-1818
  • Fax:
Mailing address:
  • Phone: 801-399-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13580799-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: