Healthcare Provider Details

I. General information

NPI: 1225473499
Provider Name (Legal Business Name): CHELSEA CHRISTINA BRINKERHOFF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHELSEA CHRISTINA BOWMAN

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 E 1000 S
PLEASANT GROVE UT
84062-3623
US

IV. Provider business mailing address

459 E 1000 S
PLEASANT GROVE UT
84062-3623
US

V. Phone/Fax

Practice location:
  • Phone: 385-501-3351
  • Fax:
Mailing address:
  • Phone: 385-501-3351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9074891-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: