Provider Demographics
NPI:1336616457
Name:SANFORD, ALISA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:ANN
Last Name:SANFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:768 W 575 S
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2611
Mailing Address - Country:US
Mailing Address - Phone:208-390-2529
Mailing Address - Fax:
Practice Address - Street 1:130 W MAIN ST STE F
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2100
Practice Address - Country:US
Practice Address - Phone:385-685-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8723337-35011041C0700X
UT8723337-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical