Provider Demographics
NPI:1700109287
Name:STUART, NELLE M (LCSW)
Entity type:Individual
Prefix:MS
First Name:NELLE
Middle Name:M
Last Name:STUART
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 1:4337 S 3100 W
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-9509
Mailing Address - Country:US
Mailing Address - Phone:801-430-7131
Mailing Address - Fax:
Practice Address - Street 1:3544 LINCOLN AVE
Practice Address - Street 2:#C
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-4045
Practice Address - Country:US
Practice Address - Phone:801-430-7131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT141529-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical