Healthcare Provider Details

I. General information

NPI: 1992042022
Provider Name (Legal Business Name): NICOLE HERWAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 12/10/2022
Certification Date: 12/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 E EXECUTIVE PARK DR
MURRAY UT
84117-3581
US

IV. Provider business mailing address

327 E DONNA CIR
SANDY UT
84070-3833
US

V. Phone/Fax

Practice location:
  • Phone: 385-352-3231
  • Fax:
Mailing address:
  • Phone: 801-200-4602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8021142-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: