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General NPI Number Information
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NPI Number | 1851667968
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Entity Type | Individual
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Provider Name | BRENDA K SWAN LMSW
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Gender | Female
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Dates
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Enumeration Date | 03/23/2012
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Last Update Date | 01/06/2016
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Provider Practice Location Address
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Address Line | 12851 GRAND RIVER RD
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City | BRIGHTON
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State | MI
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Zip | 48116-8506
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Country | US
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Telephone | 810-225-2501
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Fax |
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Provider Business Mailing Address
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Address Line | 467 DOUGLAS ST
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City | YPSILANTI
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State | MI
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Zip | 48197-2024
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Country | US
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Telephone | 734-417-8663
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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 | 6801083636
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License Number State | MI
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