Healthcare Provider Details

I. General information

NPI: 1639001092
Provider Name (Legal Business Name): OLIVIA NEILSON L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 E SOUTH TEMPLE STE 580
SALT LAKE CITY UT
84111-1349
US

IV. Provider business mailing address

3719 S 610 E
SOUTH SALT LAKE UT
84106-1143
US

V. Phone/Fax

Practice location:
  • Phone: 801-200-3372
  • Fax: 801-880-0407
Mailing address:
  • Phone: 385-867-9690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13431753-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: