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Individual

NICOLE DAHLGREN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
11620 S STATE ST STE 1404, DRAPER, UT 84020-7124
(801) 867-4488
Mailing address
4135 W 5600 N, BRIGHAM CITY, UT 84302-3512
(435) 770-1063

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
7510233-3502
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
260022408
RAILROAD MEDICARE
UT
05
876000308007
UT
Enumeration date
05/13/2010
Last updated
03/23/2022
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