Provider Demographics
NPI:1568659332
Name:MARTINEZ, ALLISON ELAINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:ELAINE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:ELAINE
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:731 E 8600 S
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-6312
Mailing Address - Country:US
Mailing Address - Phone:801-561-9987
Mailing Address - Fax:801-561-9987
Practice Address - Street 1:575 23RD ST
Practice Address - Street 2:INSIDE ELIM LUTHERAN CHURCH
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-1539
Practice Address - Country:US
Practice Address - Phone:801-561-9987
Practice Address - Fax:801-561-9987
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT365545-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical