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General NPI Number Information
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NPI Number | 1679054977
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Entity Type | Individual
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Provider Name | BRODERICK ALLAN
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Gender | Male
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Dates
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Enumeration Date | 08/24/2018
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 211 N SAGINAW RD
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City | MIDLAND
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State | MI
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Zip | 48640-3350
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Country | US
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Telephone | 989-495-8999
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Fax | 989-423-1525
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Provider Business Mailing Address
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Address Line | 1990 E 120TH ST APT 4
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City | CLEVELAND
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State | OH
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Zip | 44106-1982
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Country | US
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Telephone | 989-751-6325
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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