Provider Demographics
NPI:1558550046
Name:NICKSIC-SPRINGER, TARYN KATHLEEN (PHD)
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:KATHLEEN
Last Name:NICKSIC-SPRINGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4848 W THRUSH HILL DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-4126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:675 E 2100 S STE 270
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84106-5319
Practice Address - Country:US
Practice Address - Phone:801-448-7138
Practice Address - Fax:801-893-9012
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
UT325706-2506103K00000X
UT325706-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst