Healthcare Provider Details

I. General information

NPI: 1235056219
Provider Name (Legal Business Name): BRANDI BREUKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6376 QUAIL RUN DR STE A
KALAMAZOO MI
49009-2811
US

IV. Provider business mailing address

680 COUNTRY LN
ZEELAND MI
49464-8380
US

V. Phone/Fax

Practice location:
  • Phone: 616-848-5628
  • Fax:
Mailing address:
  • Phone: 616-848-5628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: