Provider Demographics
NPI:1093496457
Name:FRIEDT, KATELYN JOY (CLC)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:JOY
Last Name:FRIEDT
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 W JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-1909
Mailing Address - Country:US
Mailing Address - Phone:701-220-5143
Mailing Address - Fax:
Practice Address - Street 1:526 W JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-1909
Practice Address - Country:US
Practice Address - Phone:701-220-5143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty