1831873090 NPI number — JENIFER MICHELLE FREIMARK CCC-SLP

Table of content: JENIFER MICHELLE FREIMARK CCC-SLP (NPI 1831873090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831873090 NPI number — JENIFER MICHELLE FREIMARK CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREIMARK
Provider First Name:
JENIFER
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NOBLE
Provider Other First Name:
JENIFER
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831873090
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1958 MILDRED DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST BRANCH
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48661-9445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-701-4909
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 W HOUGHTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST BRANCH
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48661-1220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-701-4909
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2023

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: 235Z00000X , with the licence number:  7101007385 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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