Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 266439-3501 | UT |
NPI | 1003034240 |
---|---|
Provider Name | Mr. Doug E Nielsen |
First Address | Eden, UT 84310-1219 |
Second Address | Farmington, UT 84025-2738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |