Laura Lyn Brockbank, PH.D.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

363425-2501 Issued in UT

Practice address

1399 S 700 E
Suite 7
Salt Lake City, UT 84105-2149

Phone

(801) 483-3068

Fax

(801) 483-3072

NPI assigned

Jan 29, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780720888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1966 LINCOLN LN",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841242745",
            "telephone_number": "801-278-1139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1399 S 700 E",
            "address_2": "SUITE 7",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841052149",
            "telephone_number": "801-483-3068",
            "fax_number": "801-483-3072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCKBANK",
        "first_name": "LAURA",
        "middle_name": "LYN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "UT",
            "license": "363425-2501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kara Broadhead, ACMHC
• Keila Izcalli Nuila Broadhead
• Paul M Broadwater, D.D.S.
• Broadway Inc.
• Aubrey Noel Brock
• Stephen Brockbank, O.D.
• Mariah Brockman, LAMFT
• Douglas L. Brockmeyer, MD
• Bridget Ashley Brocksmith
• Mark Brocksmith

• Clinical Child & Adolescent Psychologist in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Clinical Child & Adolescent Psychologist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.