Healthcare Provider Details

I. General information

NPI: 1063234169
Provider Name (Legal Business Name): AUSTIN ALLISON SSW/MSWI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 S 600 E
SALT LAKE CITY UT
84102-1007
US

IV. Provider business mailing address

117 W 400 S
SALT LAKE CITY UT
84101-1916
US

V. Phone/Fax

Practice location:
  • Phone: 801-322-1001
  • Fax:
Mailing address:
  • Phone: 385-200-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9554139-3503
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: