Provider Demographics
NPI:1881663219
Name:NIMER WILSON, JANET (LCSW)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:NIMER WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:NIMER WILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:5284 S COMMERCE DR STE C134
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5360
Mailing Address - Country:US
Mailing Address - Phone:801-266-4643
Mailing Address - Fax:801-266-4775
Practice Address - Street 1:5284 S COMMERCE DR STE C134
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-266-4643
Practice Address - Fax:801-266-4775
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT273553-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11411923OtherCAQH