1134258999 NPI number — SHARON ANN SUNIVILLE LCSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134258999 NPI number — SHARON ANN SUNIVILLE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHARON ANN SUNIVILLE LCSW
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134258999
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4505 SO WASATCH BLVD
Provider Second Line Business Mailing Address:
STE 320
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-480-5944
Provider Business Mailing Address Fax Number:
801-277-8800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4505 SO WASATCH BLVD
Provider Second Line Business Practice Location Address:
STE 320
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-480-5944
Provider Business Practice Location Address Fax Number:
801-277-8800
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SUNIVILLE
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CLINICAL SOCIAL WORK PRIVATE PRACTI
Authorized Official Telephone Number:
801-480-5944

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  1317863501 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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