Provider Demographics
NPI:1902441116
Name:UTTER, NICHOLAS PAUL (APSW)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:PAUL
Last Name:UTTER
Suffix:
Gender:M
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 HIGHLAND AVENUE MAIL STOP 2424
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53792-2424
Mailing Address - Country:US
Mailing Address - Phone:608-236-8060
Mailing Address - Fax:608-262-7679
Practice Address - Street 1:122 E OLIN AVE STE 275
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1475
Practice Address - Country:US
Practice Address - Phone:608-262-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131542104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker