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NPI Code Detail

MEDICARE: JACQUELINE A NIELSON LPC

MEDICARE:   JACQUELINE A NIELSON  LPC
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
1101YM0800XMental Health Counselor6797716-6004UT

General Provider Information

NPI Number : 1720304132
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE A NIELSON LPC
Provider Business Mailing Address
First Line : 9035 S 1300 E
Second Line : SUITE B120
City : SANDY
State : UT
Zip : 84094-3132
Country : US
Telephone Number : 801-341-2001
Fax Number : 801-341-2002
Provider Business Practice Location Address
First Line : 9035 S 1300 E
Second Line : SUITE B120
City : SANDY
State : UT
Zip : 84094-3132
Country : US
Telephone Number : 801-341-2001
Fax Number : 801-341-2002
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2010
Last Update Date : 03/12/2014

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Directions to “ JACQUELINE A NIELSON LPC” Practice Location

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