Provider Demographics
NPI:1801971759
Name:COTTLE, SHARON ELIZABETH (MSW)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ELIZABETH
Last Name:COTTLE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:ELIZABETH
Other - Last Name:BOORAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1190 N 900 E
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6709
Mailing Address - Country:US
Mailing Address - Phone:801-422-7620
Mailing Address - Fax:801-422-0165
Practice Address - Street 1:1190 N 900 E
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6709
Practice Address - Country:US
Practice Address - Phone:801-422-7620
Practice Address - Fax:801-422-0165
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT31788135011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical