Most Relevant Information
Provider Data
| NPI Number: | 1003249418 |
| Provider Name: | MATTHEW KAEL NISSON |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/21/2013 |
| Last Updated: | 02/27/2017 |
Provider Practice Location
5965 S 900 E
SALT LAKE CITY
UT
841211720
Practice Location Phone/Fax
| Phone: | 8012637100 |
| Fax: |
Provider Mailing Location
5965 S 900 E
SALT LAKE CITY
UT
841211720
Provider Mailing Phone/Fax
| Phone: | 8012637100 |
| Fax: |