Provider Demographics
NPI:1740221340
Name:OLIVER, S ROLAND (LCSW)
Entity Type:Individual
Prefix:
First Name:S
Middle Name:ROLAND
Last Name:OLIVER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 BONANZA CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3103
Mailing Address - Country:US
Mailing Address - Phone:801-254-0220
Mailing Address - Fax:
Practice Address - Street 1:4250 W 5415 S
Practice Address - Street 2:FL 3
Practice Address - City:KEARNS
Practice Address - State:UT
Practice Address - Zip Code:84118-4303
Practice Address - Country:US
Practice Address - Phone:801-969-4181
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT128688-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTBC-3001OtherBCBS
UTQ41515Medicare UPIN