Healthcare Provider Details

I. General information

NPI: 1023888526
Provider Name (Legal Business Name): STEPHANIE KAY BROZEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE KAY BOCK

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5056 HENRIETTE RD
GRASSTON MN
55030-3163
US

IV. Provider business mailing address

350 JOHNSON AVE SE UNIT G12
PINE CITY MN
55063-2134
US

V. Phone/Fax

Practice location:
  • Phone: 763-370-5843
  • Fax:
Mailing address:
  • Phone: 763-370-5843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: