Basic Information
| Provider Information | |||||||||
| NPI: | 1558550046 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NICKSIC-SPRINGER | ||||||||
| FirstName: | TARYN | ||||||||
| MiddleName: | KATHLEEN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.ED. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 KOMAS DR | ||||||||
| Address2: | 200 | ||||||||
| City: | SLC | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841081215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015815515 | ||||||||
| FaxNumber: | 8015818979 | ||||||||
| Practice Location | |||||||||
| Address1: | 650 KOMAS DR | ||||||||
| Address2: | 200 | ||||||||
| City: | SLC | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841081215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015815515 | ||||||||
| FaxNumber: | 8015818979 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2007 | ||||||||
| LastUpdateDate: | 10/19/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.