Healthcare Provider Details

I. General information

NPI: 1861305971
Provider Name (Legal Business Name): ALYSSA S SMITH RD, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 WASHINGTON BLVD STE 239
OGDEN UT
84401-4055
US

IV. Provider business mailing address

3825 W 4475 S
WEST HAVEN UT
84401-9608
US

V. Phone/Fax

Practice location:
  • Phone: 801-796-2763
  • Fax: 801-996-6261
Mailing address:
  • Phone: 801-668-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number14311149-4901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: