Provider Demographics
NPI:1851897649
Name:BRODOWSKI, ERICA DENELLE
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:DENELLE
Last Name:BRODOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15547 DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-7245
Mailing Address - Country:US
Mailing Address - Phone:317-363-6347
Mailing Address - Fax:
Practice Address - Street 1:15547 DRY CREEK RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-7245
Practice Address - Country:US
Practice Address - Phone:317-363-6347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004916A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health