Provider Demographics
NPI:1326061854
Name:ALLRED, KENNETH JOEL (LCSW)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:JOEL
Last Name:ALLRED
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-0689
Mailing Address - Country:US
Mailing Address - Phone:801-451-7799
Mailing Address - Fax:801-451-6331
Practice Address - Street 1:2250 ROBINS DR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1140
Practice Address - Country:US
Practice Address - Phone:801-773-7060
Practice Address - Fax:801-774-6100
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT197117-3503104100000X
UT197117-3101164W00000X
UT197117-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No164W00000XNursing Service ProvidersLicensed Practical Nurse