Provider Demographics
NPI:1689742728
Name:SANDERS, CLOVER ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:CLOVER
Middle Name:ELIZABETH
Last Name:SANDERS
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 1:780 GUARDSMAN WAY
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1374
Mailing Address - Country:US
Mailing Address - Phone:801-481-4957
Mailing Address - Fax:801-481-4959
Practice Address - Street 1:1850 S 2500 E
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84108-3242
Practice Address - Country:US
Practice Address - Phone:801-481-4957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT634966935011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1689742728OtherBLUE CROSS