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General NPI Number Information
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NPI Number | 1164354924
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Entity Type | Individual
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Provider Name | BLAIR NICOL
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Gender | Female
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Dates
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Enumeration Date | 06/03/2026
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Last Update Date | 06/03/2026
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Provider Practice Location Address
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Address Line | 4007 S 1500 W
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City | VERNAL
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State | UT
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Zip | 84078-4665
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Country | US
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Telephone | 628-222-9621
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Fax |
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Provider Business Mailing Address
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Address Line | 4263 W TWILIGHT DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84118-4623
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 13020916-3501
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License Number State | UT
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