Provider Demographics
NPI:1811479678
Name:FREIDEL, RUTH ELEANOR (CCC-SLP)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ELEANOR
Last Name:FREIDEL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 RONALD REAGAN AVE
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80549-2401
Mailing Address - Country:US
Mailing Address - Phone:331-205-8443
Mailing Address - Fax:
Practice Address - Street 1:1671 GERONIMO RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7510
Practice Address - Country:US
Practice Address - Phone:307-399-0012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYSP-1254OtherSTATE LICENSE FOR SPEECH LANGUAGE PATHOLOGY
COSLP.0004283OtherSTATE LICENSE FOR SPEECH LANGUAGE PATHOLOGY