Provider Demographics
NPI:1821238320
Name:CHERRY, MELANEE ANNE (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:MELANEE
Middle Name:ANNE
Last Name:CHERRY
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1399 S 700 E STE 4
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2160
Mailing Address - Country:US
Mailing Address - Phone:801-652-8996
Mailing Address - Fax:
Practice Address - Street 1:1399 S 700 E STE 4
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84105-2160
Practice Address - Country:US
Practice Address - Phone:801-652-8996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT477416735011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT264040747OtherEIN