Healthcare Provider Details

I. General information

NPI: 1043569387
Provider Name (Legal Business Name): ELIZABETH KIPANA WALTON BRUMMETT-THOMAS L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH KIPANA WALTON BRUMMETT L.C.S.W.

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E 4500 S STE 570
MURRAY UT
84107-4239
US

IV. Provider business mailing address

310 E 4500 S STE 570
MURRAY UT
84107-4239
US

V. Phone/Fax

Practice location:
  • Phone: 801-262-9619
  • Fax:
Mailing address:
  • Phone: 801-262-9619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11408974-3501
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number939
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: