Healthcare Provider Details

I. General information

NPI: 1356205397
Provider Name (Legal Business Name): ISABEL BROCKMAN LICSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 CORNWALL AVE
BELLINGHAM WA
98225-3415
US

IV. Provider business mailing address

2412 CORNWALL AVE
BELLINGHAM WA
98225-3415
US

V. Phone/Fax

Practice location:
  • Phone: 206-399-7994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWIA.SC.61568297
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: