Healthcare Provider Details

I. General information

NPI: 1649915588
Provider Name (Legal Business Name): BROOKELYN ERNST LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 HAYES AVE
SANDUSKY OH
44870-4737
US

IV. Provider business mailing address

10527 STATE ROUTE 60
WAKEMAN OH
44889-9059
US

V. Phone/Fax

Practice location:
  • Phone: 419-557-5177
  • Fax:
Mailing address:
  • Phone: 440-935-3146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2208288
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: