Healthcare Provider Details

I. General information

NPI: 1033064084
Provider Name (Legal Business Name): MIA NIELSEN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 E FORT UNION BLVD STE C118
MIDVALE UT
84047-5512
US

IV. Provider business mailing address

4962 S HARVEST POINTE DR
WASHINGTON TERRACE UT
84405-6471
US

V. Phone/Fax

Practice location:
  • Phone: 866-421-6132
  • Fax:
Mailing address:
  • Phone: 801-726-7237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: