Healthcare Provider Details

I. General information

NPI: 1710075379
Provider Name (Legal Business Name): BRADLEY D. DROWN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 EAST 4800 SOUTH 230
MURRAY UT
84107
US

IV. Provider business mailing address

12274 DORAL PL.
DRAPER UT
84020
US

V. Phone/Fax

Practice location:
  • Phone: 801-261-4466
  • Fax: 801-571-6872
Mailing address:
  • Phone: 801-571-7583
  • Fax: 801-571-6872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number139246-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: