Healthcare Provider Details

I. General information

NPI: 1952051633
Provider Name (Legal Business Name): JEANETTE L NELSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10718 S OZARKS DR
SOUTH JORDAN UT
84009-5693
US

IV. Provider business mailing address

10718 S OZARKS DR
SOUTH JORDAN UT
84009-5693
US

V. Phone/Fax

Practice location:
  • Phone: 801-893-5420
  • Fax: 801-880-3873
Mailing address:
  • Phone: 801-893-5420
  • Fax: 801-880-3873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-1673
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number266279-3501
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-22512
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: