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General NPI Number Information
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NPI Number | 1700129251
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Entity Type | Individual
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Provider Name | BROOKE BENDIX L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 12/17/2014
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Provider Practice Location Address
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Address Line | 25650 OUTER DR
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City | LINCOLN PARK
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State | MI
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Zip | 48146-2096
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Country | US
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Telephone | 313-383-1897
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Fax | 313-383-6018
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Provider Business Mailing Address
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Address Line | 2015 N DAMEN AVE APT. 1R
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City | CHICAGO
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State | IL
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Zip | 60647-4548
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Country | US
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Telephone | 248-229-1198
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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 | 149015716
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License Number State | IL
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