Healthcare Provider Details

I. General information

NPI: 1447183280
Provider Name (Legal Business Name): CIERA ALEXIS WHITE MS, TRS, CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2155 GRANT AVE APT 315
OGDEN UT
84401-1583
US

IV. Provider business mailing address

2155 GRANT AVE APT 315
OGDEN UT
84401-1583
US

V. Phone/Fax

Practice location:
  • Phone: 801-888-3794
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number14239682-4002
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: