Healthcare Provider Details

I. General information

NPI: 1366367302
Provider Name (Legal Business Name): NICOLE BURTON CSW
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: NICOLE ARCHIBALD

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 CHAMBERS ST STE 14
SOUTH OGDEN UT
84403-5131
US

IV. Provider business mailing address

446 N 3600 W
OGDEN UT
84404-9578
US

V. Phone/Fax

Practice location:
  • Phone: 385-715-0233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14286841-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: