Individual
JESSICA DAURICE BROOKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2200 S STATE ST, SALT LAKE CITY, UT 84115-2724
(801) 359-8862
Mailing address
2200 S STATE ST, SALT LAKE CITY, UT 84115-2724
(801) 598-8862
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
11228416-3502
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11228416-3502
ASWB
UT
Enumeration date
05/16/2019
Last updated
05/16/2019
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