Individual
NICOLE WASSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
180 N UNIVERSITY AVE STE 270, PROVO, UT 84601-5648
(385) 442-5895
Mailing address
180 N UNIVERSITY AVE STE 270, PROVO, UT 84601-5648
(385) 442-5895
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
14265002-2506
UT
Other
Enumeration date
12/27/2019
Last updated
01/06/2026
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