Provider Demographics
NPI:1124909460
Name:NELSON, JESSICA (MFT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 E 9400 S STE 100
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3677
Mailing Address - Country:US
Mailing Address - Phone:801-252-5036
Mailing Address - Fax:
Practice Address - Street 1:870 E 9400 S STE 100
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3677
Practice Address - Country:US
Practice Address - Phone:801-252-5036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist