Healthcare Provider Details

I. General information

NPI: 1720097553
Provider Name (Legal Business Name): BROOKE ANNE SNIESAK LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3847 PINE GROVE AVE SUITE A
FORT GRATIOT MI
48059-4265
US

IV. Provider business mailing address

3111 ELECTRIC AVE
PORT HURON MI
48060-8127
US

V. Phone/Fax

Practice location:
  • Phone: 810-966-3746
  • Fax: 810-984-8111
Mailing address:
  • Phone: 810-858-9009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802080758
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: