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NPI Code Detail

MEDICARE: MS. BROOKE ROCHELLE DAVIS LICSW

MEDICARE:  MS. BROOKE ROCHELLE DAVIS  LICSW
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
11041S0200XSchool Social WorkerMN

General Provider Information

NPI Number : 1477499408
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BROOKE ROCHELLE DAVIS LICSW
Provider Business Mailing Address
First Line : 1820 XENIUM LN N
Second Line :
City : PLYMOUTH
State : MN
Zip : 55441-3708
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1820 XENIUM LN N
Second Line :
City : PLYMOUTH
State : MN
Zip : 55441-3708
Country : US
Telephone Number : 763-550-2191
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2026
Last Update Date : 04/23/2026

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Directions to “ MS. BROOKE ROCHELLE DAVIS LICSW” Practice Location

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