1760490767 NPI number — MS. SHARON C RISHE LCSW MSW

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 1760490767 NPI number — MS. SHARON C RISHE LCSW MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RISHE
Provider First Name:
SHARON
Provider Middle Name:
C
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSEBERRY
Provider Other First Name:
SHARON
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1760490767
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 EAST 4500 SOUTH
Provider Second Line Business Mailing Address:
SUITE C-150
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-288-0747
Provider Business Mailing Address Fax Number:
801-288-0761

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3940 WEST 4100 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST VALLEY CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-966-3700
Provider Business Practice Location Address Fax Number:
801-966-9421
Provider Enumeration Date:
08/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  1296053501 , 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)