Provider Demographics
NPI:1760490767
Name:RISHE, SHARON C (LCSW MSW)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:C
Last Name:RISHE
Suffix:
Gender:F
Credentials:LCSW MSW
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:ROSEBERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:555 EAST 4500 SOUTH
Mailing Address - Street 2:SUITE C-150
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-288-0747
Mailing Address - Fax:801-288-0761
Practice Address - Street 1:3940 WEST 4100 SOUTH
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120
Practice Address - Country:US
Practice Address - Phone:801-966-3700
Practice Address - Fax:801-966-9421
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12960535011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
907456Medicare UPIN