Provider Demographics
NPI:1033603667
Name:BREWIS, REBECCA ANN (LLMSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:BREWIS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:BULSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5123 OLD PLANK RD
Mailing Address - Street 2:
Mailing Address - City:ONONDAGA
Mailing Address - State:MI
Mailing Address - Zip Code:49264-9707
Mailing Address - Country:US
Mailing Address - Phone:517-628-2287
Mailing Address - Fax:517-212-8169
Practice Address - Street 1:51 S HOWELL ST
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1851
Practice Address - Country:US
Practice Address - Phone:517-262-7650
Practice Address - Fax:734-212-8169
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011029221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty