Provider Demographics
NPI:1679154892
Name:ALEXANDER, AVERY (CSW)
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:AVERY
Other - Middle Name:
Other - Last Name:REDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:10482 S GOLDEN WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4236
Mailing Address - Country:US
Mailing Address - Phone:510-610-4157
Mailing Address - Fax:
Practice Address - Street 1:5500 W BAGLEY PARK RD
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-5697
Practice Address - Country:US
Practice Address - Phone:801-282-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical