Active NPI
Jessica Daurice Brooks
- Clinical Social Worker
- Salt Lake City, UT
National Provider Identifier
1265098081
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 11228416-3502
- Practice address
- 2200 S State St
Salt Lake City, UT 84115-2724 - Phone
- (801) 359-8862
- NPI assigned
- May 16, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 11228416-3502 | UT | Primary |
Addresses
Primary practice location
2200 S State St
Salt Lake City, UT 84115-2724
Mailing address
2200 S State St
Salt Lake City, UT 84115-2724
Phone (801) 598-8862
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11228416-3502 | Other | UT | ASWB |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11228416-3502 | UT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557964800000",
"number": "1265098081",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2200 S STATE ST",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841152724",
"telephone_number": "801-598-8862"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 S STATE ST",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841152724",
"telephone_number": "801-359-8862"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROOKS",
"first_name": "JESSICA",
"middle_name": "DAURICE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-16",
"last_updated": "2019-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "UT",
"license": "11228416-3502",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASWB",
"identifier": "11228416-3502",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.