Provider Demographics
NPI:1225058993
Name:BROUWER, RICHARD W (CSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:BROUWER
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 STATE ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4328
Mailing Address - Country:US
Mailing Address - Phone:616-913-1808
Mailing Address - Fax:616-913-1818
Practice Address - Street 1:61 COMMERCE AVE SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4124
Practice Address - Country:US
Practice Address - Phone:616-235-2612
Practice Address - Fax:616-913-1818
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010180091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
D16260001Medicare ID - Type Unspecified
MIB43360Medicare UPIN
MIP32930033Medicare ID - Type Unspecified