Healthcare Provider Details

I. General information

NPI: 1598076382
Provider Name (Legal Business Name): BRAD ALLEN MESSENGER MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 01/28/2024
Certification Date: 01/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 S US HIGHWAY 27
SAINT JOHNS MI
48879-2437
US

IV. Provider business mailing address

1505 WATERFORD PKWY
SAINT JOHNS MI
48879-9630
US

V. Phone/Fax

Practice location:
  • Phone: 989-224-3000
  • Fax:
Mailing address:
  • Phone: 989-292-3572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801092156
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: