Provider Demographics
NPI:1467847897
Name:FRYE, JOAN MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIE
Last Name:FRYE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 AVALON COVE CIR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-8495
Mailing Address - Country:US
Mailing Address - Phone:615-330-4507
Mailing Address - Fax:844-593-1507
Practice Address - Street 1:128 AVALON COVE CIR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-8495
Practice Address - Country:US
Practice Address - Phone:615-330-4507
Practice Address - Fax:844-593-1507
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3208103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical