Provider Demographics
NPI:1982479499
Name:TERRY, ALISON (CSW)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:TERRY
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 1:1123 W 1060 S
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-3991
Mailing Address - Country:US
Mailing Address - Phone:435-631-0465
Mailing Address - Fax:
Practice Address - Street 1:276 E 950 S STE 200
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-7054
Practice Address - Country:US
Practice Address - Phone:801-477-7732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6539908-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker