Provider Demographics
NPI:1700367018
Name:MONTGOMERY, NICOLE TRUMP (CSW)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:TRUMP
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:TRUMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 E DICKENS PL
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2505
Mailing Address - Country:US
Mailing Address - Phone:801-882-5752
Mailing Address - Fax:
Practice Address - Street 1:857 E 200 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2317
Practice Address - Country:US
Practice Address - Phone:801-487-3276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11256813502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker