Provider Demographics
NPI:1730544479
Name:WETSCH, BROOKE E (LISW)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:E
Last Name:WETSCH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:E
Other - Last Name:PFEFFERLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:2780 AIRPORT DR
Mailing Address - Street 2:STE 100
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-2289
Mailing Address - Country:US
Mailing Address - Phone:614-859-1906
Mailing Address - Fax:614-645-5517
Practice Address - Street 1:1180 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1902
Practice Address - Country:US
Practice Address - Phone:614-645-5535
Practice Address - Fax:614-645-5517
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
51500646101YM0800X
OHI.17007401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health