Individual
BROOKE WILY IBANEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2578 W 600 N STE 102, LINDON, UT 84042-1260
(385) 220-0770
(385) 900-1637
Mailing address
552 N 1540 W, LINDON, UT 84042-2076
(801) 919-4854
(385) 900-1637
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
52622313502
UT
Other
Enumeration date
06/26/2014
Last updated
03/14/2025
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