Provider Demographics
NPI:1417070384
Name:BREWER, JERRY LYNN (MSW)
Entity Type:Individual
Prefix:MS
First Name:JERRY
Middle Name:LYNN
Last Name:BREWER
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 1:405 E MANSUR AVE
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-3343
Mailing Address - Country:US
Mailing Address - Phone:405-260-0788
Mailing Address - Fax:405-282-3305
Practice Address - Street 1:1916 E PERKINS AVE
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-5804
Practice Address - Country:US
Practice Address - Phone:405-282-8232
Practice Address - Fax:405-282-3305
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical