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General NPI Number Information
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NPI Number | 1104144203
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Entity Type | Individual
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Provider Name | NICOLE DAHLGREN LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/13/2010
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 11620 S STATE ST STE 1404
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City | DRAPER
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State | UT
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Zip | 84020-7124
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Country | US
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Telephone | 801-867-4488
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Fax |
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Provider Business Mailing Address
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Address Line | 4135 W 5600 N
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City | BRIGHAM CITY
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State | UT
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Zip | 84302-3512
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Country | US
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Telephone | 435-770-1063
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 7510233-3502
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License Number State | UT
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