Provider Demographics
NPI:1558550046
Name:NICKSIC-SPRINGER, TARYN KATHLEEN (MED)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:KATHLEEN
Last Name:NICKSIC-SPRINGER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 KOMAS DR
Mailing Address - Street 2:200
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1215
Mailing Address - Country:US
Mailing Address - Phone:801-581-5515
Mailing Address - Fax:801-581-8979
Practice Address - Street 1:650 KOMAS DR
Practice Address - Street 2:200
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84108-1215
Practice Address - Country:US
Practice Address - Phone:801-581-5515
Practice Address - Fax:801-581-8979
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor