1972858918 NPI number — MS. CHERYL CHICK SJOBERG M.S.W., L.I.C.S.W.

Table of content: MS. CHERYL CHICK SJOBERG M.S.W., L.I.C.S.W. (NPI 1972858918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972858918 NPI number — MS. CHERYL CHICK SJOBERG M.S.W., L.I.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SJOBERG
Provider First Name:
CHERYL
Provider Middle Name:
CHICK
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.W., L.I.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VAUGHN
Provider Other First Name:
CHERYL
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S.W., L.I.C.S.W.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972858918
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 E. TEMPLE STREET
Provider Second Line Business Mailing Address:
V.A. AMBULATORY CARE CENTER
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90012-3328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-253-5050
Provider Business Mailing Address Fax Number:
213-253-5123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 E. TEMPLE STREET
Provider Second Line Business Practice Location Address:
V.A. AMBULATORY CARE CENTER
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90012-3328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-253-5050
Provider Business Practice Location Address Fax Number:
213-253-5123
Provider Enumeration Date:
07/16/2012

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: 225C00000X , with the licence number:  00004750 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00004750 . This is a "DEPARTMENT OF HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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