Provider Demographics
NPI:1073844759
Name:WHITE, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5242 SOUTH 4820 WEST
Mailing Address - Street 2:
Mailing Address - City:KEARNS
Mailing Address - State:UT
Mailing Address - Zip Code:84118
Mailing Address - Country:US
Mailing Address - Phone:801-966-4251
Mailing Address - Fax:801-966-4289
Practice Address - Street 1:450 S 900 E
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84102-2981
Practice Address - Country:US
Practice Address - Phone:801-532-1850
Practice Address - Fax:801-532-3608
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7380942-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker