Provider Demographics
NPI:1538674064
Name:FREITAG, LINDA MARIE (MHS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:FREITAG
Suffix:
Gender:F
Credentials:MHS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 ROLLING LN
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-2333
Mailing Address - Country:US
Mailing Address - Phone:262-903-8393
Mailing Address - Fax:
Practice Address - Street 1:401 HERELEY DR
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:IL
Practice Address - Zip Code:60033-8370
Practice Address - Country:US
Practice Address - Phone:181-594-3612
Practice Address - Fax:815-943-6125
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.014084235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6225041BMedicaid