Provider Demographics
NPI:1548787278
Name:FREUNDL, TIMOTHY ERIC
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ERIC
Last Name:FREUNDL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 VALLIE LN
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-9534
Mailing Address - Country:US
Mailing Address - Phone:715-572-4035
Mailing Address - Fax:
Practice Address - Street 1:3600 STEWART AVE STE B
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3944
Practice Address - Country:US
Practice Address - Phone:715-842-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6252-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional