Individual
BROOKE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-4760
(801) 373-0639
Mailing address
750 N 200 W, PROVO, UT 84604-7510
(720) 933-5799
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10375300-3502
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/29/2016
Last updated
05/30/2017
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