Provider Demographics
NPI:1194007500
Name:FREITAG, KARL DOUGLAS (MA LMSW)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:DOUGLAS
Last Name:FREITAG
Suffix:
Gender:M
Credentials:MA LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 KIMBERLY RD.
Mailing Address - Street 2:STE #155
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722
Mailing Address - Country:US
Mailing Address - Phone:563-359-7625
Mailing Address - Fax:563-459-0494
Practice Address - Street 1:2435 KIMBERLY RD.
Practice Address - Street 2:STE #155
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722
Practice Address - Country:US
Practice Address - Phone:563-359-7625
Practice Address - Fax:563-459-0494
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA016041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical