Provider Demographics
NPI:1730797325
Name:CREGG, BRANDY JO
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:JO
Last Name:CREGG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:JO
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7690 WILDE LN
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-8475
Mailing Address - Country:US
Mailing Address - Phone:231-736-7105
Mailing Address - Fax:
Practice Address - Street 1:7690 WILDE LN
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-8475
Practice Address - Country:US
Practice Address - Phone:231-736-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical