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NPI Code Detail

MEDICARE: CHRYSTAL BRACKEN

MEDICARE: CHRYSTAL BRACKEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker13410071-3501UT

General Provider Information

NPI Number : 1700554110
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRYSTAL BRACKEN
Provider Business Mailing Address
First Line : 1258 W SOUTH JORDAN PKWY STE 202
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-4712
Country : US
Telephone Number : 801-255-1155
Fax Number : 801-255-0281
Provider Business Practice Location Address
First Line : 1258 W SOUTH JORDAN PKWY STE 202
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-4712
Country : US
Telephone Number : 801-255-1155
Fax Number : 801-255-0281
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2021
Last Update Date : 01/13/2026

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Directions to “ CHRYSTAL BRACKEN ” Practice Location

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