Individual
JENISSA NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1140 W 1130 S SUITE B, OREM, UT 84058
(801) 935-4171
Mailing address
1812 W 1120 S, SPRINGVILLE, UT 84663-3542
(801) 669-6377
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-17-27668
UT
1041S0200X
School Social Worker
—
—
Other
Enumeration date
09/27/2014
Last updated
02/21/2020
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