Provider Demographics
NPI:1477308914
Name:BRONKEMA, MELISSA JEANNE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JEANNE
Last Name:BRONKEMA
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 1:8650 ACORN AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALTO
Mailing Address - State:MI
Mailing Address - Zip Code:49302-9767
Mailing Address - Country:US
Mailing Address - Phone:616-460-7878
Mailing Address - Fax:
Practice Address - Street 1:121 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-1208
Practice Address - Country:US
Practice Address - Phone:269-716-1705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)