Healthcare Provider Details

I. General information

NPI: 1487329850
Provider Name (Legal Business Name): NICKKI CHAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 5600 S STE 110
MURRAY UT
84107-8153
US

IV. Provider business mailing address

111 E 5600 S STE 110
MURRAY UT
84107-8153
US

V. Phone/Fax

Practice location:
  • Phone: 866-375-2437
  • Fax: 408-273-6905
Mailing address:
  • Phone: 866-375-2437
  • Fax: 408-273-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: