Provider Demographics
NPI:1821026923
Name:ARRIETA, NELLIE M (L CSW)
Entity Type:Individual
Prefix:
First Name:NELLIE
Middle Name:M
Last Name:ARRIETA
Suffix:
Gender:F
Credentials:L CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 520477
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84152-0477
Mailing Address - Country:US
Mailing Address - Phone:801-652-8813
Mailing Address - Fax:
Practice Address - Street 1:2290 E 4500 S
Practice Address - Street 2:SUITE 110
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4492
Practice Address - Country:US
Practice Address - Phone:801-652-8813
Practice Address - Fax:801-415-9525
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT134859-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
13485935001001OtherBLUE CROSS BLUE SHIELD
UT000060652Medicare UPIN