Provider Demographics
NPI:1801045885
Name:COAKLEY, FRIEDA MARIE (MS/CCC - SLP)
Entity Type:Individual
Prefix:
First Name:FRIEDA
Middle Name:MARIE
Last Name:COAKLEY
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 1:911 S WAYFARE TRL
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-8704
Mailing Address - Country:US
Mailing Address - Phone:262-965-2082
Mailing Address - Fax:262-965-5086
Practice Address - Street 1:911 S WAYFARE TRL
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-8704
Practice Address - Country:US
Practice Address - Phone:262-965-2082
Practice Address - Fax:262-965-5086
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI288-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist