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NPI Code Detail

MEDICARE: BROOKE GADDY LMSW

MEDICARE: BROOKE GADDY LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker6801095704MI
21041C0700XClinical Social Worker6801095704MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174941652
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE GADDY LMSW
Provider Business Mailing Address
First Line : 300 68TH ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49548-6927
Country : US
Telephone Number : 616-258-7599
Fax Number : 616-222-4571
Provider Business Practice Location Address
First Line : 320 COMMERCE AVE SW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-4101
Country : US
Telephone Number : 616-258-7599
Fax Number : 616-222-4571
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2014
Last Update Date : 03/26/2025

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Directions to “ BROOKE GADDY LMSW” Practice Location

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