Individual provider Active NPI

Brooke Gaddy, LMSW

  • Clinical Social Worker
  • Grand Rapids, MI
National Provider Identifier
1174941652
Registry record updated Mar 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801095704 Issued in MI
Practice address
320 Commerce Ave SW
Grand Rapids, MI 49503-4101
Phone
(616) 258-7599
Fax
(616) 222-4571
NPI assigned
Apr 2, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 6801095704 MI
Clinical Social Worker 1041C0700X 6801095704 MI Primary

Addresses

Primary practice location

320 Commerce Ave SW
Grand Rapids, MI 49503-4101

Mailing address

300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 258-7599

Other practice location 1

790 Fuller Ave NE
Grand Rapids, MI 49503-1918
Phone (616) 336-3909

Other practice location 2

1870 Leonard St NE
Grand Rapids, MI 49505-5650
Phone (616) 945-9519

Other identifiers 1

IdentifierTypeStateIssuer
1174941652MedicaidMI

Other names 1

  • Brooke Squibb Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170808000660 MI Practitioner - Clinical Social Worker 5991076044 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1870 Leonard St NE
Christian Counseling Center Ministry of Pin
Grand Rapids, MI 49505-5650
Phone (616) 956-9619

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801095704MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Rest Christian Mental Health Services Social Worker CurrentSince Jul 21, 2017 Accepting new patients
Pine Rest Christian Mental Health Services CurrentSince Jul 21, 2017 Accepting new patients

Locations

1870 Leonard St NE
Grand Rapids, MI 49505
Phone (616) 956-1122

320 Commerce Ave SW
Grand Rapids, MI 49503
Phone (616) 222-4570

300 68th St SE
Wyoming, MI 49548
Phone (616) 455-5000

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742947200000",
    "number": "1174941652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-258-7599",
            "fax_number": "616-222-4571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 COMMERCE AVE SW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034101",
            "telephone_number": "616-258-7599",
            "fax_number": "616-222-4571"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "790 Fuller Ave NE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495031918",
            "country_code": "US",
            "telephone_number": "616-336-3909",
            "fax_number": "616-336-8830",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1870 Leonard St NE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495055650",
            "country_code": "US",
            "telephone_number": "616-945-9519",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GADDY",
        "first_name": "BROOKE",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-02",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801095704",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801095704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174941652",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BROOKE",
            "last_name": "SQUIBB",
            "credential": "LMSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.