Provider Demographics
NPI:1114197324
Name:FRIED, RHONDA (BC, APN)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:FRIED
Suffix:
Gender:F
Credentials:BC, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 STONEGATE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5614
Mailing Address - Country:US
Mailing Address - Phone:224-678-9180
Mailing Address - Fax:224-678-9369
Practice Address - Street 1:265 STONEGATE RD STE 102
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5614
Practice Address - Country:US
Practice Address - Phone:224-678-9180
Practice Address - Fax:224-678-9369
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-190833364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult