Provider Demographics
NPI:1104131697
Name:SCHWISOW, NIKKI (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:NIKKI
Middle Name:
Last Name:SCHWISOW
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:MANSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:8537 S REDWOOD RD STE C
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5713
Mailing Address - Country:US
Mailing Address - Phone:385-449-2200
Mailing Address - Fax:
Practice Address - Street 1:8537 S REDWOOD RD STE C
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5713
Practice Address - Country:US
Practice Address - Phone:385-449-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT8034933-35011041C0700X
TX1056171041C0700X
VA09040144391041C0700X
OHI.21030131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT876000308007Medicaid
UT876000308007Medicaid