Provider Demographics
NPI:1588235972
Name:OLIVE, SYDNEY SALOME (CSW)
Entity Type:Individual
Prefix:MISS
First Name:SYDNEY
Middle Name:SALOME
Last Name:OLIVE
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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 1:453 N 200 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-1208
Practice Address - Country:US
Practice Address - Phone:661-414-2953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12278177-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker