Provider Demographics
NPI:1760613434
Name:LOHRBACH, SUZANNE E (LICSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:E
Last Name:LOHRBACH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 5TH ST E
Mailing Address - Street 2:
Mailing Address - City:MANTORVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55955-8088
Mailing Address - Country:US
Mailing Address - Phone:507-287-2010
Mailing Address - Fax:507-287-7805
Practice Address - Street 1:1110 6TH ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-1839
Practice Address - Country:US
Practice Address - Phone:507-287-2010
Practice Address - Fax:507-287-7805
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN011721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN064257600Medicaid
8G185HAOtherBLUE CROSS BLUE SHIELD