NPIMap

Individual provider Active NPI

Nicole Manon Fenwick, LCSW

  • Clinical Social Worker
  • Salt Lake City, UT
National Provider Identifier
1235457094
Registry record updated Dec 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
50039293501 Issued in UT
Practice address
1111 Brickyard Rd
Suite #109
Salt Lake City, UT 84106-2560
Phone
(801) 746-4334
NPI assigned
May 4, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 27, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 50039293501 UT Primary

Addresses

Primary practice location

1111 Brickyard Rd
Suite #109
Salt Lake City, UT 84106-2560

Mailing address

1111 Brickyard Rd
Suite #109
Salt Lake City, UT 84106-2560
Phone (801) 746-4334

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nfenwick29957@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
50039293501UTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Jewish Family Service PastSince May 14, 2014 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: nfenwick29957@direct.med.utah.edu

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1272931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640563200000",
    "number": "1235457094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 BRICKYARD RD",
            "address_2": "SUITE #109",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841062560",
            "telephone_number": "801-746-4334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 BRICKYARD RD",
            "address_2": "SUITE #109",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841062560",
            "telephone_number": "801-746-4334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENWICK",
        "first_name": "NICOLE",
        "middle_name": "MANON",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-05-04",
        "last_updated": "2021-12-27",
        "certification_date": "2021-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "50039293501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nfenwick29957@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.