Healthcare Provider Details

I. General information

NPI: 1720579501
Provider Name (Legal Business Name): ALISSA SWENSON LCSW, EMDR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2018
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5137 S 1500 W
RIVERDALE UT
84405-3926
US

IV. Provider business mailing address

1045 S OREM BLVD
OREM UT
84058-6979
US

V. Phone/Fax

Practice location:
  • Phone: 801-875-2898
  • Fax:
Mailing address:
  • Phone: 801-875-2892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12158277-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: