Provider Demographics
NPI:1811333404
Name:WYN, BROOKE (MSW)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:WYN
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 1:255 COLRAIN SW
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49548
Mailing Address - Country:US
Mailing Address - Phone:616-988-1479
Mailing Address - Fax:616-988-1493
Practice Address - Street 1:1920 GODFREY AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-1415
Practice Address - Country:US
Practice Address - Phone:616-243-0533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical