Individual
KELLY DAWN BROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1300 E CENTER ST, PROVO, UT 84606
(801) 344-4400
Mailing address
PO BOX 270, PROVO, UT 84603-0270
(801) 344-4400
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9806442-3501
UT
Other
Enumeration date
08/11/2014
Last updated
07/11/2019
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