Provider Demographics
NPI:1194364802
Name:ALLRED, ANNMARIE (CASUDCI)
Entity Type:Individual
Prefix:
First Name:ANNMARIE
Middle Name:
Last Name:ALLRED
Suffix:
Gender:F
Credentials:CASUDCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 E 1475 N
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-3568
Mailing Address - Country:US
Mailing Address - Phone:801-341-0009
Mailing Address - Fax:
Practice Address - Street 1:848 E 1475 N
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-3568
Practice Address - Country:US
Practice Address - Phone:801-341-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11565761-6019101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)