Provider Demographics
NPI:1730986175
Name:GILMORE, BRYAN W W (SOCIAL WORKER CLINIC)
Entity type:Individual
Prefix:MR
First Name:BRYAN W
Middle Name:W
Last Name:GILMORE
Suffix:
Gender:M
Credentials:SOCIAL WORKER CLINIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3385 S 5475 W
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-1455
Mailing Address - Country:US
Mailing Address - Phone:801-520-7986
Mailing Address - Fax:
Practice Address - Street 1:12569 S 2700 W
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7182
Practice Address - Country:US
Practice Address - Phone:801-209-9797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
UT9868995-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical