Provider Demographics
NPI:1104903079
Name:FRIEDLI, KATHRYN A (LISW, MSW)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:FRIEDLI
Suffix:
Gender:F
Credentials:LISW, MSW
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:W
Other - Last Name:FRIEDLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW, MSW
Mailing Address - Street 1:2720 STONE PARK BLVD
Mailing Address - Street 2:ST LUKES RGIONAL MEDICAL CENTER
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104
Mailing Address - Country:US
Mailing Address - Phone:712-279-3500
Mailing Address - Fax:712-279-3929
Practice Address - Street 1:2720 STONE PARK BLVD
Practice Address - Street 2:ST LUKES RGIONAL MEDICAL CENTER
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104
Practice Address - Country:US
Practice Address - Phone:712-279-3500
Practice Address - Fax:712-279-3929
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA048471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA31715OtherWELLMARK BCBS
IAI19766Medicare PIN