Healthcare Provider Details

I. General information

NPI: 1023651403
Provider Name (Legal Business Name): BROOKE KRAESZIG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3496 E LAKE LANSING RD STE 100
EAST LANSING MI
48823-6222
US

IV. Provider business mailing address

27777 INKSTER RD STE 100
FARMINGTON HILLS MI
48334-5326
US

V. Phone/Fax

Practice location:
  • Phone: 517-862-1615
  • Fax:
Mailing address:
  • Phone: 248-436-4476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851116104
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: