Healthcare Provider Details

I. General information

NPI: 1699042176
Provider Name (Legal Business Name): SHARI LYN GILLINS SSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 E RIVERSIDE DR STE 301
ST GEORGE UT
84790-8722
US

IV. Provider business mailing address

617 E RIVERSIDE DR STE 301
ST GEORGE UT
84790-8722
US

V. Phone/Fax

Practice location:
  • Phone: 435-216-7000
  • Fax: 435-216-7001
Mailing address:
  • Phone: 435-216-7000
  • Fax: 435-216-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number104614-3503
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: