Provider Demographics
NPI:1588040273
Name:COBURN, PATRICIA SUE
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:SUE
Last Name:COBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:SUE
Other - Last Name:BRODERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:422 S MURDOCK DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3278
Mailing Address - Country:US
Mailing Address - Phone:801-319-6769
Mailing Address - Fax:
Practice Address - Street 1:170 S INTERSTATE PLZ STE 100
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-8601
Practice Address - Country:US
Practice Address - Phone:385-236-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT135358-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical