DR. LAURA LYN BROCKBANK (NPI# 1780720888) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1780720888 |
Entity Type | Individual |
Full Name | DR. LAURA LYN BROCKBANK |
Credential | PH.D. |
Practice Address |
1399 S 700 E Suite 7 Salt Lake City UT 84105-2149 |
Mailing Address |
1966 Lincoln Ln Salt Lake City UT 84124-2745 |
Practice Telephone | 8014833068 |
Practice Fax Number | 8014833072 |
Mailing Telephone | 8012781139 |
Enumeration Date | 2007-01-29 |
Last Update Date | 2007-07-08 |
Gender Code | F |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
363425-2501 | UT | Behavioral Health & Social Service Providers |
Street Address |
1399 S 700 E SUITE 7 |
City | SALT LAKE CITY |
State | UT |
Zip Code | 84105-2149 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1720066442 | Debra Marie Quackenbush | Psychologist | 1399 S 700 E, Salt Lake City, UT 84105-2160 | 2006-01-03 |
1396133815 | Kellie Clement | Social Worker | 1399 S 700 E, Suite 1, Salt Lake City, UT 84105-2149 | 2015-01-06 |
1477837573 | Jason Durtschi | Social Worker | 1399 S 700 E, Salt Lake City, UT 84105-2149 | 2011-10-06 |
1376737676 | James M Struve Inc | Social Worker | 1399 S 700 E, Suite #2, Salt Lake City, UT 84105-2149 | 2007-08-29 |
1851583702 | Jeffrey Alan Bell | Social Worker | 1399 S 700 E, Suite 1, Salt Lake City, UT 84105-2149 | 2007-08-14 |
1013111996 | Charlotte J Ferrin | Psychologist | 1399 S 700 E, Suite 11, Salt Lake City, UT 84105-2149 | 2007-06-13 |
1043429749 | Kevin Del Lambert | Psychiatry & Neurology | 1399 S 700 E, Suite 5b, Salt Lake City, UT 84105-2149 | 2007-05-21 |
1851507057 | Pamela Swibel Plant | Psychologist | 1399 S 700 E, Suite 7, Salt Lake City, UT 84105-2149 | 2007-05-15 |
1235344763 | Kenneth L. Critchfield II | Psychologist | 1399 S 700 E, #9, Salt Lake City, UT 84105-2149 | 2007-05-10 |
1861613853 | Gary Joel Klein | Social Worker | 1399 S 700 E, Suite 11b, Salt Lake City, UT 84105-2149 | 2007-05-01 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1285106237 | Laiyan H Bawadeen | Counselor | 1425 700 E Suite #102, Salt Lake City, UT 84105 | 2018-12-31 |
1639644255 | Claire Elizabeth Gray | Marriage & Family Therapist | 1425 700 East, Salt Lake City, UT 84105 | 2018-10-10 |
1083089643 | Celisa Packer | Social Worker | 2020 E Lake St, Salt Lake City, UT 84105 | 2015-12-08 |
1083052963 | Christina Elizabeth Burton | Nurse Practitioner | 1008 S 1100 E, Apt 6, Salt Lake City, UT 84105 | 2013-06-12 |
1649548355 | Leland Burt Cowan | Surgery | 1405 Princeton Ave, Salt Lake City, UT 84105 | 2011-12-08 |
1639460355 | Sally Cathleen Webster | Counselor | 1248 Yale Avenue, Salt Lake City, UT 84105 | 2011-04-28 |
1912205105 | Melissa Wilson | Case Manager/Care Coordinator | 1522 S 1100 E, Salt Lake City, UT 84105 | 2011-03-11 |
1013215789 | Tamara Marie Wright | Counselor | 1996 Lake St, Salt Lake City, UT 84105 | 2011-03-04 |
1144527243 | Crystal Nicole Garduno | Counselor | 1522 South 1100 East, Salt Lake City, UT 84105 | 2011-02-25 |
1508011180 | Keith Elliott | Anesthesiology | 1552 South 1000 East, Salt Lake City, UT 84105 | 2008-11-24 |
Find all providers in zip 84105 |
Taxonomy Code | 103TC2200X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Psychologist |
Specialization | Clinical Child & Adolescent |
Definition to come... |
Notes: [1/1/2007: title modified] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1477913762 | Lisa Daniels | Psychologist | 4568 S Highland Dr Ste 260b, Salt Lake City, UT 84117-4236 | 2016-02-29 |
1386945566 | Annie Michol Deming | Psychologist | 5770 S 1500 W # G, Salt Lake City, UT 84123-5216 | 2010-11-04 |
1588829634 | Carla J Reyes | Psychologist | 4568 S Highland Dr Ste 100, Salt Lake City, UT 84117-4234 | 2008-07-28 |
1265592083 | Fenster Corp. | Psychologist | 4505 Wasatch Blvd Ste 380, Salt Lake City, UT 84124-4733 | 2006-12-11 |
1174625016 | Donald Emory Beck | Psychologist | 44 Medical Dr, Salt Lake City, UT 84132-0001 | 2006-09-01 |
1376570820 | Douglas Frank Goldsmith | Psychologist | 5383 S 900 E Ste 290, Salt Lake City, UT 84117-7268 | 2006-06-27 |
1457808370 | Jennifer Wehan | Psychologist | 350 S 400 E, Salt Lake City, UT 84111-2905 | 2016-09-08 |
1386016061 | Renee Kathleen Burke | Psychologist | 1945 S 1100 E, Suite 206, Salt Lake City, UT 84106-2369 | 2015-10-21 |
1346637881 | Natalie Buerger | Psychologist | 295 S Chipeta Way, Salt Lake City, UT 84108-1287 | 2015-04-22 |
1568864114 | Amanda Aulbaugh | Psychologist | 350 S 400 E, Salt Lake City, UT 84111-2908 | 2014-09-25 |
Find all providers in SALT LAKE CITY |
City | SALT LAKE CITY |
Zip Code | 84105 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.