Provider Demographics
NPI:1588235972
Name:SHULTZ, SYDNEY SALOME (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SYDNEY
Middle Name:SALOME
Last Name:SHULTZ
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:SALOME
Other - Last Name:OLIVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:453 N 200 W
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-1208
Mailing Address - Country:US
Mailing Address - Phone:661-414-2953
Mailing Address - Fax:
Practice Address - Street 1:950 E 3300 S
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84106-2141
Practice Address - Country:US
Practice Address - Phone:385-500-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1227817735011041C0700X
UT12278177-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker