Provider Demographics
NPI:1922508092
Name:MICKEL, PENNY DELYNNE-ROSENBROOK
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:DELYNNE-ROSENBROOK
Last Name:MICKEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:DELYNNE
Other - Last Name:ROSENBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COUNSELOR
Mailing Address - Street 1:15361 ELM ROW RD
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-9610
Mailing Address - Country:US
Mailing Address - Phone:517-206-2517
Mailing Address - Fax:
Practice Address - Street 1:155 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-3407
Practice Address - Country:US
Practice Address - Phone:269-968-9287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional