Provider Demographics
NPI:1932686599
Name:SAMPSON, ALLISON (MED)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1204 S 900 E APT D
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-1357
Mailing Address - Country:US
Mailing Address - Phone:801-577-6556
Mailing Address - Fax:
Practice Address - Street 1:358 S 700 E STE B307
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2161
Practice Address - Country:US
Practice Address - Phone:801-577-6556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst