Ashley Carolina Brog, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

8572468-3502 Issued in UT

Practice address

75 W 100 S Ste 200
Logan, UT 84321-5842

Phone

(801) 822-2109

NPI assigned

Jun 13, 2013

Last updated

May 13, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Ashley Carolina Graham Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Willow Haven Counseling LLC

  dba Willow Haven Counseling - Carolina Brog, LCSW

  • Clinical Social Worker
  • Logan, UT
  • NPI 1124676739
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715558400000",
    "number": "1053759985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1934 N 1200 E",
            "city": "NORTH LOGAN",
            "state": "UT",
            "postal_code": "843412006",
            "telephone_number": "801-822-2109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 W 100 S STE 200",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843215842",
            "telephone_number": "801-822-2109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROG",
        "first_name": "ASHLEY",
        "middle_name": "CAROLINA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-13",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "8572468-3502",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "8572468-3501",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ASHLEY",
            "last_name": "GRAHAM",
            "middle_name": "CAROLINA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bridge Utah Medical Group
• Kelsey Nicole Brimhall
• Katerina Briscoe
• Lee S Broadbent, MD
• Michael L Broadbent, D.O.
• Christopher Brower
• Kendall Gilbert Brown, FNP-BC
• Nicole Brown, LCSW
• Nordell T Brown, MD
• Toni Tiffany Brown

• Clinical Social Worker in Logan, UT
• Providers in Logan, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.