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NPI Code Detail

MEDICARE: ELLEN KRISTINE BROKL LICSW

MEDICARE: ELLEN KRISTINE BROKL LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker32915MN

General Provider Information

NPI Number : 1881558781
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN KRISTINE BROKL LICSW
Provider Business Mailing Address
First Line : 6244 2ND AVE S
Second Line :
City : RICHFIELD
State : MN
Zip : 55423-1617
Country : US
Telephone Number : 612-269-7305
Fax Number :
Provider Business Practice Location Address
First Line : 2525 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-4518
Country : US
Telephone Number : 612-813-7157
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2025
Last Update Date : 12/15/2025

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