Individual
STACY LYNN NICKELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
4000 S 700 E STE 9, SALT LAKE CITY, UT 84107-2581
(801) 635-4141
Mailing address
4000 S 700 E STE 9, SALT LAKE CITY, UT 84107-2581
(801) 635-4141
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
08/08/2018
Last updated
08/08/2018
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