MEDICARE: NICOLE LINNAE BOOTH

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1992131999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE LINNAE BOOTH

Provider Business Mailing Address
First Line	:	857 E 200 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-2317
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 N MAIN ST
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-4800
Country	:	US
Telephone Number	:	385-319-1107
Fax Number	:

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

Provider Enumeration Date	:	09/23/2013
Last Update Date	:	04/09/2026

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Directions to “ NICOLE LINNAE BOOTH ” Practice Location

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