Provider Demographics
NPI:1346230802
Name:MUSSO, ALISON JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:JANE
Last Name:MUSSO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2892 COVE LN
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-2415
Mailing Address - Country:US
Mailing Address - Phone:801-292-7143
Mailing Address - Fax:801-478-2781
Practice Address - Street 1:1545 E 3300 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3370
Practice Address - Country:US
Practice Address - Phone:801-478-2780
Practice Address - Fax:801-478-2781
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1174072501103TA0700X, 103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT11740725003001OtherBCBS
UTQ19324OtherSTERLING
UTQ19324Medicare UPIN