Provider Demographics
NPI:1013962448
Name:STINSON, SHERILYN CLARKE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHERILYN
Middle Name:CLARKE
Last Name:STINSON
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 1:1666 PAULISTA WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6724
Mailing Address - Country:US
Mailing Address - Phone:801-943-5348
Mailing Address - Fax:
Practice Address - Street 1:4250 W 5415 S
Practice Address - Street 2:THIRD FLOOR
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:801-969-1291
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTLCSW 370347-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTB0928Medicaid
UT37034735000001OtherBCBS PROCLAIM TRACKING #
UTQ41514Medicare UPIN