Provider Demographics
NPI:1689400434
Name:BROUWER, BRENNA (LLMSW)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:BROUWER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6228 BLENDON DR APT 201
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-8043
Mailing Address - Country:US
Mailing Address - Phone:219-781-9513
Mailing Address - Fax:
Practice Address - Street 1:3925 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-9402
Practice Address - Country:US
Practice Address - Phone:616-379-0338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
68511188971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical