Provider Demographics
NPI:1154392876
Name:FREBOWITZ, LOUISE B (MSPA CCC)
Entity type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:B
Last Name:FREBOWITZ
Suffix:
Gender:F
Credentials:MSPA CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19115
Mailing Address - Country:US
Mailing Address - Phone:215-969-5650
Mailing Address - Fax:205-969-5651
Practice Address - Street 1:9500 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19115
Practice Address - Country:US
Practice Address - Phone:215-969-5650
Practice Address - Fax:205-969-5651
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000222L237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
5635453OtherAETNA
R06708Medicare UPIN
FR226161Medicare ID - Type Unspecified