Healthcare Provider Details

I. General information

NPI: 1265364343
Provider Name (Legal Business Name): BROOKLYN WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3082 E 700 S
SPANISH FORK UT
84660-5841
US

IV. Provider business mailing address

173 N 500 W
OREM UT
84057-1949
US

V. Phone/Fax

Practice location:
  • Phone: 866-805-1199
  • Fax:
Mailing address:
  • Phone: 801-678-3472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14288316-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: