=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841496924
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONI D BICKLEY LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2007
-----------------------------------------------------
Last Update Date | 12/12/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 54 N 200 E
-----------------------------------------------------
City | CEDAR CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84720-2615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-586-2515
-----------------------------------------------------
Fax | 435-865-7606
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 54 NORTH 100 EAST
-----------------------------------------------------
City | CEDAR CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84720-3091
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-586-2515
-----------------------------------------------------
Fax | 435-865-7606
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 4810438-3501
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------