Individual
KRISTY BRUBAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
425 E 5350 S STE 205, WASHINGTON TERRACE, UT 84405-6943
(801) 851-5554
Mailing address
425 E 5350 S STE 205, WASHINGTON TERRACE, UT 84405-6943
(801) 851-5554
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
11461339-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95-2633765
MEDI-CAL
CA
Enumeration date
12/09/2015
Last updated
04/18/2025
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