Provider Demographics
NPI:1609196468
Name:ALLRED, JESSICA ELDER (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELDER
Last Name:ALLRED
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:ELDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:1998 MAPLE HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-1041
Mailing Address - Country:US
Mailing Address - Phone:801-856-8897
Mailing Address - Fax:801-207-8313
Practice Address - Street 1:563 W 500 S STE 440
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8296
Practice Address - Country:US
Practice Address - Phone:801-872-3234
Practice Address - Fax:801-207-8313
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT73592453502104100000X
UT7359245-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker