MEDICARE: MICHELLE MARKAY NELSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	340220-3501	UT

General Provider Information

NPI Number	:	1427196849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE MARKAY NELSON LCSW

Provider Business Mailing Address
First Line	:	1355 S 1100 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2432
Country	:	US
Telephone Number	:	801-557-8960
Fax Number	:	801-484-2348

Provider Business Practice Location Address
First Line	:	1355 S 1100 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2432
Country	:	US
Telephone Number	:	801-557-8960
Fax Number	:	801-484-2348

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	11/30/2021

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