Provider Demographics
NPI:1083133979
Name:MULDER, JOANNA FRIEDA
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:FRIEDA
Last Name:MULDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 ELMWOOD AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-4955
Mailing Address - Country:US
Mailing Address - Phone:847-401-8989
Mailing Address - Fax:
Practice Address - Street 1:902 ELMWOOD AVE APT 2
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-4955
Practice Address - Country:US
Practice Address - Phone:847-401-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.013260101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional