Breanna Lynn Bolo, L-LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801120588 Issued in MI

Practice address

2353 Badger Street
Marquette, MI 49855-2303

Phone

(906) 273-1121

Fax

(906) 225-6706

NPI assigned

Jun 6, 2023

Last updated

Oct 23, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Breanna Lynn Shaw Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761177600000",
    "number": "1982398509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2353 BADGER STREET",
            "address_2": "2353 BADGER STREET",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498552303",
            "telephone_number": "906-273-1121",
            "fax_number": "906-225-6706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2353 BADGER STREET",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498552303",
            "telephone_number": "906-273-1121",
            "fax_number": "906-225-6706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLO",
        "first_name": "BREANNA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "L-LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-06",
        "last_updated": "2025-10-23",
        "certification_date": "2025-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801120588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BREANNA",
            "last_name": "SHAW",
            "middle_name": "LYNN",
            "credential": "L-LMSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Holly Ann Boburka, MS A.T.,C.
• Holly Beth Bodjanac-Reinhart, MSW
• Body Mechanix Physical Therapy of Marquette, LLC
• Ginger Kay Bohl, MD
• Bob Boivin, CADC
• Kimberly Marie Bonetti, FNP-BC
• Rachel Bonsall, FNP-BC
• Sarah Boogren
• Merlen D Borgialli, ATC
• Andrew Gerard Boudreau, N.P.

• Clinical Social Worker in Marquette, MI
• Providers in Marquette, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.