Provider Demographics
NPI:1083102891
Name:SANDVIK, STACI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STACI
Middle Name:
Last Name:SANDVIK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3466 CHAPARRAL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7560
Mailing Address - Country:US
Mailing Address - Phone:801-830-8924
Mailing Address - Fax:
Practice Address - Street 1:107 S 1470 E STE 104
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-1749
Practice Address - Country:US
Practice Address - Phone:801-830-8924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8407078-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical