Provider Demographics
NPI:1891305546
Name:ALLWOOD, LINDSAY (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:ALLWOOD
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:ALLWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, BCBA
Mailing Address - Street 1:3910 W BURGESS RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-3540
Mailing Address - Country:US
Mailing Address - Phone:559-916-0544
Mailing Address - Fax:
Practice Address - Street 1:3006 S HIGHLAND DR STE 210
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-6004
Practice Address - Country:US
Practice Address - Phone:801-674-5352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1-20-42867103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst