MEDICARE: MEGAN BROCK LLMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		MI

General Provider Information

NPI Number	:	1477219434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN BROCK LLMSW

Provider Business Mailing Address
First Line	:	7854 MOORING CT
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-9799
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 PEARL ST NW STE 341
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-3026
Country	:	US
Telephone Number	:	616-485-7082
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2021
Last Update Date	:	11/15/2021

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