Healthcare Provider Details

I. General information

NPI: 1225866254
Provider Name (Legal Business Name): KADEE JO ALLRED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 S 800 E
OREM UT
84097-7230
US

IV. Provider business mailing address

479 S 1700 E
SPRINGVILLE UT
84663-2711
US

V. Phone/Fax

Practice location:
  • Phone: 801-704-5066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13983476-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: