Provider Demographics
NPI:1609769454
Name:CARLSON-FROELICH, FAITH HELENE
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:HELENE
Last Name:CARLSON-FROELICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N BRAMBLE ST
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950-9303
Mailing Address - Country:US
Mailing Address - Phone:815-802-3700
Mailing Address - Fax:
Practice Address - Street 1:3535 JOHN ST
Practice Address - Street 2:
Practice Address - City:STEGER
Practice Address - State:IL
Practice Address - Zip Code:60475-1315
Practice Address - Country:US
Practice Address - Phone:708-539-7960
Practice Address - Fax:708-539-7960
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health