Provider Demographics
NPI:1639617962
Name:FREUDENBERGER, JANE LOUISE
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:LOUISE
Last Name:FREUDENBERGER
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 1:2424 LUKE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5197
Mailing Address - Country:US
Mailing Address - Phone:225-405-5928
Mailing Address - Fax:
Practice Address - Street 1:748 BAYOU PINES EAST DR STE B
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7596
Practice Address - Country:US
Practice Address - Phone:225-405-5928
Practice Address - Fax:337-214-1836
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA46841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical