Provider Demographics
NPI:1679993182
Name:FROELICH, SHANTEL MARIE (LBSW)
Entity Type:Individual
Prefix:
First Name:SHANTEL
Middle Name:MARIE
Last Name:FROELICH
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:SHANTEL
Other - Middle Name:MARIE
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:ND
Mailing Address - Zip Code:58054-0628
Mailing Address - Country:US
Mailing Address - Phone:701-683-6135
Mailing Address - Fax:701-683-4491
Practice Address - Street 1:205 4TH AVE W
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:ND
Practice Address - Zip Code:58054-4109
Practice Address - Country:US
Practice Address - Phone:701-683-6135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4848104100000X
MN22807104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker