Healthcare Provider Details

I. General information

NPI: 1518822212
Provider Name (Legal Business Name): ALYSSA JAYNE HENDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W 1275 N
LAYTON UT
84041-7718
US

IV. Provider business mailing address

2501 W 1275 N
LAYTON UT
84041-7718
US

V. Phone/Fax

Practice location:
  • Phone: 801-510-1470
  • Fax:
Mailing address:
  • Phone: 801-510-1470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberBL24-445
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: