Provider Demographics
NPI:1033507736
Name:FREUNDL, PATRICIA (LMSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:FREUNDL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7989 S PORTAGE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-8524
Mailing Address - Country:US
Mailing Address - Phone:231-631-4583
Mailing Address - Fax:
Practice Address - Street 1:4205 CHARLAR DR
Practice Address - Street 2:SUITE 3
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-6810
Practice Address - Country:US
Practice Address - Phone:231-631-4583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-03
Last Update Date:2015-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010895451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical