Healthcare Provider Details

I. General information

NPI: 1023070844
Provider Name (Legal Business Name): SHERI CAROLYN SHORT CSW-PIP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 NORTH AVE
SPEARFISH SD
57783-1525
US

IV. Provider business mailing address

1320 NORTH AVE
SPEARFISH SD
57783-1525
US

V. Phone/Fax

Practice location:
  • Phone: 866-802-0003
  • Fax:
Mailing address:
  • Phone: 866-802-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3693
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8632
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15437
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2956
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: