MEDICARE: BROOKLYN WILSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	14288316-3502	UT

General Provider Information

NPI Number	:	1265364343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKLYN WILSON

Provider Business Mailing Address
First Line	:	173 N 500 W
Second Line	:
City	:	OREM
State	:	UT
Zip	:	84057-1949
Country	:	US
Telephone Number	:	801-678-3472
Fax Number	:

Provider Business Practice Location Address
First Line	:	3082 E 700 S
Second Line	:
City	:	SPANISH FORK
State	:	UT
Zip	:	84660-5841
Country	:	US
Telephone Number	:	866-805-1199
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “ BROOKLYN WILSON ” Practice Location

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