Individual
BROOKE ILLIG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3481 POINTER RD, WEST BRANCH, MI 48661-9624
(989) 787-0640
Mailing address
3481 POINTER RD, WEST BRANCH, MI 48661-9624
(989) 787-0640
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
6801098067
MI
1041C0700X
Clinical Social Worker
Primary
6801098067
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194174623
—
MI
Enumeration date
06/06/2016
Last updated
02/23/2022
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