Healthcare Provider Details

I. General information

NPI: 1699694224
Provider Name (Legal Business Name): KELSEY NICOLE BRIMHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

175 W 1400 N
LOGAN UT
84341-6811
US

IV. Provider business mailing address

175 W 1400 N
LOGAN UT
84341-6811
US

V. Phone/Fax

Practice location:
  • Phone: 435-752-5302
  • Fax:
Mailing address:
  • Phone: 435-752-5302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: