Provider Demographics
NPI:1972858918
Name:SJOBERG, CHERYL CHICK (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:CHICK
Last Name:SJOBERG
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:LOUISE
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:315 E. TEMPLE STREET
Mailing Address - Street 2:V.A. AMBULATORY CARE CENTER
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-3328
Mailing Address - Country:US
Mailing Address - Phone:213-253-5050
Mailing Address - Fax:213-253-5123
Practice Address - Street 1:315 E. TEMPLE STREET
Practice Address - Street 2:V.A. AMBULATORY CARE CENTER
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-3328
Practice Address - Country:US
Practice Address - Phone:213-253-5050
Practice Address - Fax:213-253-5123
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00004750225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00004750OtherDEPARTMENT OF HEALTH