Healthcare Provider Details

I. General information

NPI: 1730707076
Provider Name (Legal Business Name): BROOKE STOCKETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1785 E 1450 S STE 130
CLEARFIELD UT
84015-2295
US

IV. Provider business mailing address

1514 W PARKVIEW DR
SYRACUSE UT
84075-9851
US

V. Phone/Fax

Practice location:
  • Phone: 801-871-5118
  • Fax:
Mailing address:
  • Phone: 801-871-5118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11984732-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11984732-3503
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: