Provider Demographics
NPI:1609829860
Name:FREIBURGER, JAMES G (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:FREIBURGER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:DOUSMAN
Mailing Address - State:WI
Mailing Address - Zip Code:53118-0212
Mailing Address - Country:US
Mailing Address - Phone:262-751-5672
Mailing Address - Fax:855-702-2180
Practice Address - Street 1:2717 N GRANDVIEW BLVD STE 202
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1660
Practice Address - Country:US
Practice Address - Phone:262-751-5527
Practice Address - Fax:855-702-2180
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1950103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39679300Medicaid