Provider Demographics
NPI:1255768941
Name:FROELICH, BRIAN (LSW)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:FROELICH
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24011 PEAR TREE CIR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585
Mailing Address - Country:US
Mailing Address - Phone:815-690-3130
Mailing Address - Fax:
Practice Address - Street 1:1289 WINDHAM PARKWAY
Practice Address - Street 2:
Practice Address - City:ROMOEVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446
Practice Address - Country:US
Practice Address - Phone:630-759-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150013930104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker