Provider Demographics
NPI:1710292479
Name:FREDE, SALLY ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:FREDE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 N WOODBINE RD
Mailing Address - Street 2:STE E
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2431
Mailing Address - Country:US
Mailing Address - Phone:816-232-1744
Mailing Address - Fax:816-232-2942
Practice Address - Street 1:1807 N WOODBINE RD
Practice Address - Street 2:STE E
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2431
Practice Address - Country:US
Practice Address - Phone:816-232-1744
Practice Address - Fax:816-232-2942
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080128041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical