Provider Demographics
NPI:1598801755
Name:FRESE, ELIZABETH K (LICSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:FRESE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14025 NE 63RD CT
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4661
Mailing Address - Country:US
Mailing Address - Phone:425-242-0986
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:BOX 356125
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6125
Practice Address - Country:US
Practice Address - Phone:206-598-4370
Practice Address - Fax:206-598-6333
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1109061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical