Provider Demographics
NPI:1053759985
Name:BROG, ASHLEY CAROLINA (LCSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CAROLINA
Last Name:BROG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:CAROLINA
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1934 N 1200 E
Mailing Address - Street 2:
Mailing Address - City:NORTH LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2006
Mailing Address - Country:US
Mailing Address - Phone:801-822-2109
Mailing Address - Fax:
Practice Address - Street 1:75 W 100 S STE 200
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-5842
Practice Address - Country:US
Practice Address - Phone:801-822-2109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8572468-35021041C0700X
UT8572468-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical