Provider Demographics
NPI:1104184712
Name:FRIEDEL, JENNY REBECCA MOHR (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:REBECCA MOHR
Last Name:FRIEDEL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-4130
Mailing Address - Country:US
Mailing Address - Phone:608-754-4235
Mailing Address - Fax:
Practice Address - Street 1:1831 W COURT ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-3406
Practice Address - Country:US
Practice Address - Phone:608-754-7463
Practice Address - Fax:608-754-1437
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4870-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist