Provider Demographics
NPI:1194085423
Name:FLAGG, SHERIE ANN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:SHERIE
Middle Name:ANN
Last Name:FLAGG
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2253 LAGO LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:GRACE
Mailing Address - State:ID
Mailing Address - Zip Code:83241-5330
Mailing Address - Country:US
Mailing Address - Phone:435-864-8575
Mailing Address - Fax:435-417-3113
Practice Address - Street 1:61 E 1ST S
Practice Address - Street 2:
Practice Address - City:SODA SPRINGS
Practice Address - State:ID
Practice Address - Zip Code:83276-1437
Practice Address - Country:US
Practice Address - Phone:435-864-8575
Practice Address - Fax:435-417-3113
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8011742-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical