Healthcare Provider Details

I. General information

NPI: 1629984893
Provider Name (Legal Business Name): BROOKELYN BLONQUIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKELYN HUMPHERYS

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E BIG BEAVER RD STE C
TROY MI
48083-1432
US

IV. Provider business mailing address

448 FOX HILLS DR S APT 2
BLOOMFIELD HILLS MI
48304-1352
US

V. Phone/Fax

Practice location:
  • Phone: 734-600-7873
  • Fax:
Mailing address:
  • Phone:
  • 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: