1558448217 NPI number — AMY FREADLING LPCC

Table of content: AMY FREADLING LPCC (NPI 1558448217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558448217 NPI number — AMY FREADLING LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREADLING
Provider First Name:
AMY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558448217
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6000 W CREEK RD
Provider Second Line Business Mailing Address:
SUITE 20
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44131-2139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-986-1170
Provider Business Mailing Address Fax Number:
216-986-1016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20525 CENTER RIDGE RD
Provider Second Line Business Practice Location Address:
SUITE 610
Provider Business Practice Location Address City Name:
ROCKY RIVER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44116-3437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-986-1170
Provider Business Practice Location Address Fax Number:
216-986-1016
Provider Enumeration Date:
11/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  E-4250 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)