Provider Demographics
NPI:1972887750
Name:POLLEY, ALISSA BETH (CSW)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:BETH
Last Name:POLLEY
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 900245
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84090-0245
Mailing Address - Country:US
Mailing Address - Phone:801-634-8727
Mailing Address - Fax:801-733-4083
Practice Address - Street 1:11075 S STATE ST STE 28
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5176
Practice Address - Country:US
Practice Address - Phone:801-501-8444
Practice Address - Fax:801-733-4083
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1645212391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical