Provider Demographics
NPI:1740742774
Name:FRIESEN, ANNAROSE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANNAROSE
Middle Name:
Last Name:FRIESEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8905 E CESSNA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67210-2401
Mailing Address - Country:US
Mailing Address - Phone:570-947-1025
Mailing Address - Fax:
Practice Address - Street 1:1655 S GEORGETOWN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-4140
Practice Address - Country:US
Practice Address - Phone:316-685-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-31
Last Update Date:2019-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4329235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist