Provider Demographics
NPI:1942174255
Name:EDDLEMAN, NICOLA A (LCSW)
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:A
Last Name:EDDLEMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 E FORT UNION BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-5529
Mailing Address - Country:US
Mailing Address - Phone:385-412-1660
Mailing Address - Fax:800-856-3698
Practice Address - Street 1:623 E FORT UNION BLVD STE 105
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-5529
Practice Address - Country:US
Practice Address - Phone:385-412-1660
Practice Address - Fax:800-856-3698
Is Sole Proprietor?:No
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5950578-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical