Healthcare Provider Details

I. General information

NPI: 1871989707
Provider Name (Legal Business Name): CAITLYNNE BROBST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLYNNE KARTCHNER

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1459 N MAIN ST STE 100
BOUNTIFUL UT
84010-6092
US

IV. Provider business mailing address

1450 N LAKE AVE STE 150
PASADENA CA
91104-2301
US

V. Phone/Fax

Practice location:
  • Phone: 801-298-2000
  • Fax:
Mailing address:
  • Phone: 626-794-6071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10071691-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: