Provider Demographics
NPI:1336715655
Name:NIELSON, ELIZA JANE
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:JANE
Last Name:NIELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1256 S STATE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-8239
Mailing Address - Country:US
Mailing Address - Phone:801-600-0308
Mailing Address - Fax:
Practice Address - Street 1:1256 S STATE ST STE 201
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-8239
Practice Address - Country:US
Practice Address - Phone:801-600-0308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker