MEDICARE: BROOKE STOCKETT LCSW

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	11984732-3501	UT
2	104100000X	Social Worker	11984732-3503	UT

General Provider Information

NPI Number	:	1730707076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE STOCKETT LCSW

Provider Business Mailing Address
First Line	:	1514 W PARKVIEW DR
Second Line	:
City	:	SYRACUSE
State	:	UT
Zip	:	84075-9851
Country	:	US
Telephone Number	:	801-871-5118
Fax Number	:

Provider Business Practice Location Address
First Line	:	1785 E 1450 S STE 130
Second Line	:
City	:	CLEARFIELD
State	:	UT
Zip	:	84015-2295
Country	:	US
Telephone Number	:	801-871-5118
Fax Number	:

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

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	04/15/2026

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Directions to “ BROOKE STOCKETT LCSW” Practice Location

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