Provider Demographics
NPI:1992042022
Name:HERWAY, NICOLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:HERWAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 E DONNA CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3833
Mailing Address - Country:US
Mailing Address - Phone:801-200-4602
Mailing Address - Fax:
Practice Address - Street 1:925 E EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84117-3581
Practice Address - Country:US
Practice Address - Phone:385-352-3231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2022-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8021142-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical