Healthcare Provider Details

I. General information

NPI: 1528531167
Provider Name (Legal Business Name): BROOKE ANDRIA TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 W SOUTH JORDAN PKWY STE C
SOUTH JORDAN UT
84095-5511
US

IV. Provider business mailing address

2420 JUAN TABO BLVD NE
ALBUQUERQUE NM
87112-1818
US

V. Phone/Fax

Practice location:
  • Phone: 801-432-0778
  • Fax:
Mailing address:
  • Phone: 505-317-3792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1528531167
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13986947-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: