Healthcare Provider Details

I. General information

NPI: 1740911999
Provider Name (Legal Business Name): JESSICA ELDER ALLRED LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2022
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JESSICA ALLRED
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 801-856-8897