Healthcare Provider Details

I. General information

NPI: 1730871823
Provider Name (Legal Business Name): TRESSA BREWER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48578 PONTIAC TRL
WIXOM MI
48393-2554
US

IV. Provider business mailing address

16560 CHESTNUT ST
ROSEVILLE MI
48066-4312
US

V. Phone/Fax

Practice location:
  • Phone: 248-669-5263
  • Fax:
Mailing address:
  • Phone: 586-252-8763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851118391
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: