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General NPI Number Information
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NPI Number | 1740911999
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Entity Type | Organization
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Legal Business Name | JESSICA ELDER ALLRED LCSW
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Dates
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Enumeration Date | 06/20/2022
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 563 W 500 S STE 440
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City | BOUNTIFUL
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State | UT
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Zip | 84010-8296
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Country | US
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Telephone | 801-679-4512
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Fax |
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Provider Business Mailing Address
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Address Line | 563 W 500 S STE 440
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City | BOUNTIFUL
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State | UT
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Zip | 84010-8296
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Country | US
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Telephone | 801-872-3234
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Fax | 801-207-8313
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | JESSICA ALLRED
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Credential | LCSW
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Telephone | 801-856-8897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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