Provider Demographics
NPI:1295757672
Name:GRABE, LORI A (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:A
Last Name:GRABE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 SOUTHWOODS CTR
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-2462
Mailing Address - Country:US
Mailing Address - Phone:618-281-9355
Mailing Address - Fax:618-281-4641
Practice Address - Street 1:276 SOUTHWOODS CTR
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-2462
Practice Address - Country:US
Practice Address - Phone:618-281-9355
Practice Address - Fax:618-281-4641
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0118461041C0700X
MO0048971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical