Healthcare Provider Details

I. General information

NPI: 1598734139
Provider Name (Legal Business Name): SLOANE SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 S 400 E
SALT LAKE CITY UT
84111-5306
US

IV. Provider business mailing address

2124 KING ST
SALT LAKE CITY UT
84109-1302
US

V. Phone/Fax

Practice location:
  • Phone: 801-783-5560
  • Fax: 801-783-5559
Mailing address:
  • Phone: 801-783-5660
  • Fax: 801-783-5559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1390103501
License Number StateUT

VII. Legacy identifiers

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

# 1
Identifier1390103501
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerSTATE PROFESSIONAL LICENS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: