Healthcare Provider Details

I. General information

NPI: 1568349041
Provider Name (Legal Business Name): ALLYSON JANE ANDERSON SUDC, SSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 E FORT UNION BLVD
MIDVALE UT
84047-1531
US

IV. Provider business mailing address

1226 W NORWALK RD
TAYLORSVILLE UT
84123-1330
US

V. Phone/Fax

Practice location:
  • Phone: 801-569-1995
  • Fax:
Mailing address:
  • Phone: 801-300-6755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13778272-6006
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13778272-3503
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: