Provider Demographics
NPI:1730312547
Name:FRIEMERING, CONNIE LYNN (MACCC/SLP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:LYNN
Last Name:FRIEMERING
Suffix:
Gender:F
Credentials:MACCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SAINT CLAIR PL
Mailing Address - Street 2:
Mailing Address - City:NEW BREMEN
Mailing Address - State:OH
Mailing Address - Zip Code:45869-9690
Mailing Address - Country:US
Mailing Address - Phone:419-629-3258
Mailing Address - Fax:
Practice Address - Street 1:1209 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-1310
Practice Address - Country:US
Practice Address - Phone:419-394-7611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSLP3160235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist