Provider Demographics
NPI:1093094351
Name:BROGDON, JOANNE STEWART (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:STEWART
Last Name:BROGDON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20206 ROGGE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-3090
Mailing Address - Country:US
Mailing Address - Phone:313-270-2070
Mailing Address - Fax:
Practice Address - Street 1:20206 ROGGE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-3090
Practice Address - Country:US
Practice Address - Phone:313-270-2070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010880951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical