Provider Demographics
NPI:1518194455
Name:LETTICH, ALYSSA (MD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:LETTICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5171 S COTTONWOOD ST
Mailing Address - Street 2:SUITE 810
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5704
Mailing Address - Country:US
Mailing Address - Phone:801-507-9800
Mailing Address - Fax:801-507-9801
Practice Address - Street 1:5171 S COTTONWOOD ST
Practice Address - Street 2:SUITE 810
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5704
Practice Address - Country:US
Practice Address - Phone:801-507-9800
Practice Address - Fax:801-507-9801
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY253399-1174400000X
NY2533992084N0400X
UT367245-12052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist