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General NPI Number Information
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NPI Number | 1194085423
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Entity Type | Individual
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Provider Name | SHERIE ANN FLAGG MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 61 E 1ST S
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City | SODA SPRINGS
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State | ID
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Zip | 83276-1437
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Country | US
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Telephone | 435-864-8575
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Fax | 435-417-3113
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Provider Business Mailing Address
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Address Line | 2253 LAGO LIBERTY RD
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City | GRACE
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State | ID
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Zip | 83241-5330
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Country | US
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Telephone | 435-864-8575
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Fax | 435-417-3113
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8011742-3501
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License Number State | UT
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