Basic Information
| Provider Information | |||||||||
| NPI: | 1659645232 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERSH | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 S. 500 E | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015876336 | ||||||||
| FaxNumber: | 8017158228 | ||||||||
| Practice Location | |||||||||
| Address1: | 1477 N 2000 W | ||||||||
| Address2: | SUITE E | ||||||||
| City: | CLINTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840158638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016145866 | ||||||||
| FaxNumber: | 8018251162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/29/2012 | ||||||||
| LastUpdateDate: | 07/29/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC2200X | 9101783-2501 | UT | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No ID Information.