Provider Demographics
NPI:1609006915
Name:FIFE, LAUREN SLOANE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:SLOANE
Last Name:FIFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLANDING
Mailing Address - State:UT
Mailing Address - Zip Code:84511-3830
Mailing Address - Country:US
Mailing Address - Phone:435-678-2992
Mailing Address - Fax:435-678-3116
Practice Address - Street 1:356 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLANDING
Practice Address - State:UT
Practice Address - Zip Code:84511-3830
Practice Address - Country:US
Practice Address - Phone:435-678-2992
Practice Address - Fax:435-678-3116
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7360745-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical