Provider Demographics
NPI:1356168355
Name:KORTH, BREANNA DANA (CSW)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:DANA
Last Name:KORTH
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 N 2170 S APT N11
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737
Mailing Address - Country:US
Mailing Address - Phone:208-573-7177
Mailing Address - Fax:
Practice Address - Street 1:230 N1680 E
Practice Address - Street 2:SUITE D-1
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-705-9571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13500682-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical