Individual
NICOLE M GOTBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SSW
Contact information
Practice address
195 N 1950 W, SALT LAKE CITY, UT 84116-3100
(801) 538-4001
Mailing address
195 N 1950 W, SALT LAKE CITY, UT 84116-3100
(385) 315-3237
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
9450078-3503
UT
253J00000X
Foster Care Agency
—
—
Other
Enumeration date
08/05/2013
Last updated
09/22/2015
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