Provider Demographics
NPI:1962794164
Name:KORMAN, NICOLE KATRINA (LCSW, SUDC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:KATRINA
Last Name:KORMAN
Suffix:
Gender:F
Credentials:LCSW, SUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 S HIGHLAND DR
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3753
Mailing Address - Country:US
Mailing Address - Phone:801-739-3754
Mailing Address - Fax:
Practice Address - Street 1:7105 S HIGHLAND DR
Practice Address - Street 2:SUITE #101
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-3753
Practice Address - Country:US
Practice Address - Phone:801-783-4779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6242266-6006101YA0400X
UT6242266-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)