Basic Information
| Provider Information | |||||||||
| NPI: | 1073844759 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | SARA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5242 SOUTH 4820 WEST | ||||||||
| Address2: | |||||||||
| City: | KEARNS | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019664251 | ||||||||
| FaxNumber: | 8019664289 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 S 900 E | ||||||||
| Address2: | |||||||||
| City: | SLC | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841022981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015321850 | ||||||||
| FaxNumber: | 8015323608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2010 | ||||||||
| LastUpdateDate: | 01/04/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 7380942-3502 | UT | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.