Provider Demographics
NPI:1205182540
Name:FRIESZ, KENDRA DAWN (RD LDN)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:DAWN
Last Name:FRIESZ
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:MRS
Other - First Name:KENDRA
Other - Middle Name:DAWN
Other - Last Name:FRIESZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LDN
Mailing Address - Street 1:2401 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:MO
Mailing Address - Zip Code:64424-1352
Mailing Address - Country:US
Mailing Address - Phone:660-868-0408
Mailing Address - Fax:
Practice Address - Street 1:720 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAMONI
Practice Address - State:IA
Practice Address - Zip Code:50140-1512
Practice Address - Country:US
Practice Address - Phone:641-784-6981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC997303133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered