Provider Demographics
NPI:1033148739
Name:MOULDING, CHERYL IONE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:IONE
Last Name:MOULDING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:IONE
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:237 26TH ST
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-3105
Mailing Address - Country:US
Mailing Address - Phone:810-625-3692
Mailing Address - Fax:810-625-3615
Practice Address - Street 1:237 26TH ST
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-3105
Practice Address - Country:US
Practice Address - Phone:810-625-3692
Practice Address - Fax:810-625-3615
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT493967035011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT876000308007Medicaid
UT876000308007Medicaid