Provider Demographics
NPI:1437879376
Name:FRANTZICH, KORENA
Entity Type:Individual
Prefix:
First Name:KORENA
Middle Name:
Last Name:FRANTZICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-5406
Mailing Address - Country:US
Mailing Address - Phone:406-563-0260
Mailing Address - Fax:406-259-1777
Practice Address - Street 1:1810 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-5406
Practice Address - Country:US
Practice Address - Phone:406-563-0260
Practice Address - Fax:406-259-1777
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician