Individual
BROOKELIE MARY BAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
128 COUNTRY CLUB DR, STANSBURY PARK, UT 84074-9143
(208) 703-1222
Mailing address
128 COUNTRY CLUB DR, STANSBURY PARK, UT 84074-9143
(208) 703-1222
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
99-3423588
UT
Other
Enumeration date
01/07/2026
Last updated
01/07/2026
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