Provider Demographics
NPI:1346492873
Name:FROESE, JENNIFER F (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:F
Last Name:FROESE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:DYSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:116 W FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:KS
Mailing Address - Zip Code:67579-1516
Mailing Address - Country:US
Mailing Address - Phone:620-204-8504
Mailing Address - Fax:
Practice Address - Street 1:103 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:KS
Practice Address - Zip Code:67554-1927
Practice Address - Country:US
Practice Address - Phone:620-312-3861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
KS2181103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist