=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700106895
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMUEL FILIKITONGA BROWN MSW,CSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2010
-----------------------------------------------------
Last Update Date | 02/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9160 S 300 W STE 4
-----------------------------------------------------
City | SANDY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84070-2656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-254-4710
-----------------------------------------------------
Fax | 801-341-8345
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9160 S 300 W STE 4
-----------------------------------------------------
City | SANDY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84070-2656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-254-4710
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 14124639-3502
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------