Provider Demographics
NPI:1023070844
Name:SHORT, SHERI CAROLYN (CSW-PIP)
Entity type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:CAROLYN
Last Name:SHORT
Suffix:
Gender:F
Credentials:CSW-PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-1525
Mailing Address - Country:US
Mailing Address - Phone:866-802-0003
Mailing Address - Fax:
Practice Address - Street 1:1320 NORTH AVE
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-1525
Practice Address - Country:US
Practice Address - Phone:866-802-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK36931041C0700X
SC86321041C0700X
MN154371041C0700X
SD29561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical