MEDICARE: SHARON GUTHRIE L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1208-C	AR

General Provider Information

NPI Number	:	1467588707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON GUTHRIE L.C.S.W.

Provider Business Mailing Address
First Line	:	1188 N SALEM RD STE 10
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72704-8808
Country	:	US
Telephone Number	:	479-530-4190
Fax Number	:	479-582-2630

Provider Business Practice Location Address
First Line	:	1188 N SALEM RD STE 10
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72704-8808
Country	:	US
Telephone Number	:	479-530-4190
Fax Number	:	479-582-2630

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/08/2007

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