Individual
GARY EARL BRUNDAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5640 S 3500 W, ROY, UT 84067-9158
(017) 732-8388
(801) 773-3025
Mailing address
713 HISLOP DR, OGDEN, UT 84404-6809
(801) 814-4376
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
7435-C
NV
1041C0700X
Clinical Social Worker
Primary
8666499-3501
UT
Other
Enumeration date
08/12/2010
Last updated
07/29/2022
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