Provider Demographics
NPI:1760734982
Name:FREIHEIT, STACY RAE (PHD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:RAE
Last Name:FREIHEIT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 SAWGRASS TRAIL WEST
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123
Mailing Address - Country:US
Mailing Address - Phone:651-955-6738
Mailing Address - Fax:
Practice Address - Street 1:3300 EDINBOROUGH WAY
Practice Address - Street 2:SUITE 650
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5923
Practice Address - Country:US
Practice Address - Phone:952-854-2622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4554103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical