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NPI Code Detail

MEDICARE: MRS. BREANNA LYNN BOLO L-LMSW

MEDICARE: MRS. BREANNA LYNN BOLO L-LMSW
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
11041C0700XClinical Social Worker6801120588MI

General Provider Information

NPI Number : 1982398509
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BREANNA LYNN BOLO L-LMSW
Provider Business Mailing Address
First Line : 2353 BADGER STREET
Second Line : 2353 BADGER STREET
City : MARQUETTE
State : MI
Zip : 49855-2303
Country : US
Telephone Number : 906-273-1121
Fax Number : 906-225-6706
Provider Business Practice Location Address
First Line : 2353 BADGER STREET
Second Line :
City : MARQUETTE
State : MI
Zip : 49855-2303
Country : US
Telephone Number : 906-273-1121
Fax Number : 906-225-6706
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2023
Last Update Date : 10/23/2025

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Directions to “ MRS. BREANNA LYNN BOLO L-LMSW” Practice Location

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