Healthcare Provider Details

I. General information

NPI: 1336055524
Provider Name (Legal Business Name): ALLEGRA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 E 900 S STE 212
SALT LAKE CITY UT
84111-4251
US

IV. Provider business mailing address

PO BOX 520554
SALT LAKE CITY UT
84152-0554
US

V. Phone/Fax

Practice location:
  • Phone: 801-503-9174
  • Fax: 385-406-6865
Mailing address:
  • Phone: 801-503-9174
  • Fax: 385-406-6865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: STACY ACKERLIND
Title or Position: OWNER/PSYCHOLOGIST
Credential: PH.D.
Phone: 801-503-9174