Provider Demographics
NPI:1659477495
Name:FRAENKEL, REBECCA R (LP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:R
Last Name:FRAENKEL
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 HIGHWAY 96 E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3624
Mailing Address - Country:US
Mailing Address - Phone:651-426-3071
Mailing Address - Fax:651-426-3095
Practice Address - Street 1:1310 HIGHWAY 96 E
Practice Address - Street 2:SUITE 200
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3624
Practice Address - Country:US
Practice Address - Phone:651-426-3071
Practice Address - Fax:651-426-3095
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6853103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist