Provider Demographics
NPI:1740923325
Name:GRONLI, BREANNA MAE (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:MAE
Last Name:GRONLI
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 60TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-9140
Mailing Address - Country:US
Mailing Address - Phone:320-894-1207
Mailing Address - Fax:
Practice Address - Street 1:2120 60TH AVE NE
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-9140
Practice Address - Country:US
Practice Address - Phone:320-894-1207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN308751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty