Provider Demographics
NPI:1497711352
Name:DEPAOLI, STEPHANIE R (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:DEPAOLI
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 1:4190 S HIGHLAND DR
Mailing Address - Street 2:STE 202
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2786
Mailing Address - Country:US
Mailing Address - Phone:801-425-1458
Mailing Address - Fax:
Practice Address - Street 1:4190 S HIGHLAND DR
Practice Address - Street 2:STE 202
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-2786
Practice Address - Country:US
Practice Address - Phone:801-425-1458
Practice Address - Fax:801-906-0129
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT$$$$$$$$$05001OtherBCBS
UT$$$$$$$$$05001OtherBCBS