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General NPI Number Information
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NPI Number | 1316342025
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Entity Type | Organization
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Legal Business Name | NICOLE K KORMAN PLLC
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Dates
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Enumeration Date | 10/24/2014
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Last Update Date | 10/24/2014
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Provider Practice Location Address
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Address Line | 7105 S HIGHLAND DR STE 101
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84121-7314
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Country | US
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Telephone | 801-739-3754
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Fax |
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Provider Business Mailing Address
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Address Line | 7105 S HIGHLAND DR STE 101
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84121-7314
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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 | OWNER/OPERATOR
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Name | NICOLE KORMAN
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Credential | LCSW
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Telephone | 801-739-3754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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