Healthcare Provider Details

I. General information

NPI: 1811824899
Provider Name (Legal Business Name): ALLISON BLAINE OCONNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALLISON OCONNOR BLAINE

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 E MURPHYS LN APT A
MILLCREEK UT
84106-2933
US

IV. Provider business mailing address

1413 E MURPHYS LN APT A
MILLCREEK UT
84106-2933
US

V. Phone/Fax

Practice location:
  • Phone: 801-455-6142
  • Fax:
Mailing address:
  • Phone: 801-455-6142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7445610-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: