Provider Demographics
NPI:1184680670
Name:FRIESWYK, SIEBOLT HENRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:SIEBOLT
Middle Name:HENRY
Last Name:FRIESWYK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6810 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66610-1415
Mailing Address - Country:US
Mailing Address - Phone:785-478-4516
Mailing Address - Fax:785-842-9772
Practice Address - Street 1:1201 WAKARUSA DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-1892
Practice Address - Country:US
Practice Address - Phone:785-842-9772
Practice Address - Fax:785-842-5231
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS209103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical