Provider Demographics
NPI:1720488141
Name:FREISE, CHRISTINA (MS, CCC-SLP, CBIS)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:
Last Name:FREISE
Suffix:
Gender:F
Credentials:MS, CCC-SLP, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 FIFTH AVE S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6632
Mailing Address - Country:US
Mailing Address - Phone:516-395-2359
Mailing Address - Fax:
Practice Address - Street 1:780 FIFTH AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6632
Practice Address - Country:US
Practice Address - Phone:516-395-2359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13537235Z00000X
IA002211235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist