Provider Demographics
NPI:1750176962
Name:NIELSEN, PORSHAI
Entity type:Individual
Prefix:
First Name:PORSHAI
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 E 4800 S STE 250C
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5039
Mailing Address - Country:US
Mailing Address - Phone:801-882-7149
Mailing Address - Fax:
Practice Address - Street 1:825 E 4800 S STE 250C
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-5039
Practice Address - Country:US
Practice Address - Phone:801-882-7149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker