Provider Demographics
NPI:1598734139
Name:SMITH, SLOANE (LCSW)
Entity Type:Individual
Prefix:
First Name:SLOANE
Middle Name:
Last Name:SMITH
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 1:2124 KING ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1302
Mailing Address - Country:US
Mailing Address - Phone:801-783-5660
Mailing Address - Fax:801-783-5559
Practice Address - Street 1:124 S 400 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-5306
Practice Address - Country:US
Practice Address - Phone:801-783-5560
Practice Address - Fax:801-783-5559
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13901035011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1390103501OtherSTATE PROFESSIONAL LICENS