Healthcare Provider Details

I. General information

NPI: 1609196468
Provider Name (Legal Business Name): JESSICA ELDER ALLRED L.C.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ELDER C.S.W

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N 500 E STE 120
NORTH SALT LAKE UT
84054-1949
US

IV. Provider business mailing address

1998 MAPLE HOLLOW WAY
BOUNTIFUL UT
84010-1041
US

V. Phone/Fax

Practice location:
  • Phone: 801-872-3234
  • Fax: 801-207-8313
Mailing address:
  • Phone: 801-856-8897
  • Fax: 801-207-8313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7359245-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number73592453502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: