Provider Demographics
NPI:1285072579
Name:BROICH, LORI (LSW)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:BROICH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SILVERWOOD AVENUE PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:MARBLE
Mailing Address - State:MN
Mailing Address - Zip Code:55764
Mailing Address - Country:US
Mailing Address - Phone:218-256-6109
Mailing Address - Fax:
Practice Address - Street 1:990 W 41ST ST
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-3045
Practice Address - Country:US
Practice Address - Phone:218-256-6109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12325104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker