Individual
GARY V BROADBENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
5030 HARRISON BLVD, OGDEN, UT 84403-4311
(801) 550-6712
Mailing address
2757 E 3600 S, SALT LAKE CITY, UT 84109-3546
(801) 550-6712
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
113385-3501
UT
Other
Enumeration date
12/03/2008
Last updated
12/03/2008
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