Provider Demographics
NPI:1033442645
Name:WHITE, CHERYL LYNN (SSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:WHITE
Suffix:
Gender:F
Credentials:SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84011-0460
Mailing Address - Country:US
Mailing Address - Phone:801-298-3446
Mailing Address - Fax:801-298-3449
Practice Address - Street 1:470 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4928
Practice Address - Country:US
Practice Address - Phone:801-298-3446
Practice Address - Fax:801-298-3449
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT296150-3503104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker