Healthcare Provider Details

I. General information

NPI: 1083548952
Provider Name (Legal Business Name): MS. KAYLIE MARIE ALLRED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 E COTTONWOOD PKWY STE 500
SALT LAKE CITY UT
84121-7060
US

IV. Provider business mailing address

2495 S 200 E
CLEARFIELD UT
84015-2051
US

V. Phone/Fax

Practice location:
  • Phone: 385-469-3731
  • Fax:
Mailing address:
  • Phone: 385-394-8339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1503272
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: