Provider Demographics
NPI:1558650333
Name:ELEY, SHIRLEY ROSE (SSW)
Entity Type:Individual
Prefix:MISS
First Name:SHIRLEY
Middle Name:ROSE
Last Name:ELEY
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 1:1141 E 3900 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1215
Mailing Address - Country:US
Mailing Address - Phone:801-284-4900
Mailing Address - Fax:801-284-4901
Practice Address - Street 1:1141 EAST 3900 SOUTH
Practice Address - Street 2:
Practice Address - City:SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84124
Practice Address - Country:US
Practice Address - Phone:801-284-4900
Practice Address - Fax:801-284-4901
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT331819-3503104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker