Provider Demographics
NPI:1629577481
Name:FRICKE, HEATHER LEIGH
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEIGH
Last Name:FRICKE
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 1:4712 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49457-8820
Mailing Address - Country:US
Mailing Address - Phone:231-744-7518
Mailing Address - Fax:
Practice Address - Street 1:4712 RIVER RD
Practice Address - Street 2:
Practice Address - City:TWIN LAKE
Practice Address - State:MI
Practice Address - Zip Code:49457-8820
Practice Address - Country:US
Practice Address - Phone:231-744-7518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician