Provider Demographics
NPI:1689190191
Name:FREEDLUND, JEFFREY J (CSW)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:FREEDLUND
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 NORTH MOHRLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1190 NORTH MOHRLAND ROAD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:UT
Practice Address - Zip Code:84528
Practice Address - Country:US
Practice Address - Phone:866-542-2252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9852543-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical