Healthcare Provider Details

I. General information

NPI: 1427994409
Provider Name (Legal Business Name): BROOKLYN LAUREL CALDWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1273 W 12600 S STE 403
RIVERTON UT
84065-7111
US

IV. Provider business mailing address

2168 N 650 W
LEHI UT
84043-2939
US

V. Phone/Fax

Practice location:
  • Phone: 443-975-6577
  • Fax:
Mailing address:
  • Phone: 435-557-6650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: