Provider Demographics
NPI:1144915570
Name:ROCKWOOD, BROOKLYN
Entity type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:
Last Name:ROCKWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BROOKLYN
Other - Middle Name:
Other - Last Name:SHUMWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:867 S 800 W
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-4505
Mailing Address - Country:US
Mailing Address - Phone:801-785-9019
Mailing Address - Fax:
Practice Address - Street 1:715 N 3200 W
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-8702
Practice Address - Country:US
Practice Address - Phone:801-473-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTRBT-22-202073106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician