Provider Demographics
NPI:1588228506
Name:FREIDHOF, KAITLYN ALEXANDRIA
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ALEXANDRIA
Last Name:FREIDHOF
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 1:13014 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2341
Mailing Address - Country:US
Mailing Address - Phone:330-481-0521
Mailing Address - Fax:
Practice Address - Street 1:13014 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2341
Practice Address - Country:US
Practice Address - Phone:330-481-0521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide