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NPI Code Detail

MEDICARE: ALLYSE KATHRYN NELSON

MEDICARE: ALLYSE KATHRYN NELSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker
21041C0700XClinical Social WorkerL17596OR

General Provider Information

NPI Number : 1376055111
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLYSE KATHRYN NELSON
Provider Business Mailing Address
First Line : 3025 W 75 N
Second Line :
City : LAYTON
State : UT
Zip : 84041-5747
Country : US
Telephone Number : 801-513-9953
Fax Number :
Provider Business Practice Location Address
First Line : 655 E 1300 N
Second Line :
City : LOGAN
State : UT
Zip : 84341-2570
Country : US
Telephone Number : 435-792-6500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2017
Last Update Date : 05/13/2026

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Directions to “ ALLYSE KATHRYN NELSON ” Practice Location

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