Individual
MR. DOUGLAS BOWEN BRUNKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
780 GUARDSMAN WAY, SALT LAKE CITY, UT 84108-1374
(801) 581-0194
(801) 581-0193
Mailing address
44 W BROADWAY APT 1008, SALT LAKE CITY, UT 84101-3210
(801) 581-0194
(801) 581-0193
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1401633501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107032396101
INTRMTN. HEALTH CARE
UT
01
—
261871
DESERET MUTUAL
UT
01
—
942938348BR1
EDUCATORS MUTUAL
UT
Enumeration date
12/09/2005
Last updated
07/08/2007
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