Healthcare Provider Details

I. General information

NPI: 1801442215
Provider Name (Legal Business Name): SHERRI LYNN DOMINGUEZ CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 E TABERNACLE ST STE 100
ST GEORGE UT
84770-2951
US

IV. Provider business mailing address

948 N 1300 W
ST GEORGE UT
84770-4965
US

V. Phone/Fax

Practice location:
  • Phone: 435-705-7574
  • Fax:
Mailing address:
  • Phone: 435-628-9310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10623301-3502
License Number StateUT

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: