Provider Demographics
NPI:1194173617
Name:FREEMAN, DOUGLAS CLARK (MS; CCC-A)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:CLARK
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:MS; CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 23RD AVE SW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-2479
Mailing Address - Country:US
Mailing Address - Phone:507-322-4241
Mailing Address - Fax:
Practice Address - Street 1:201 23RD AVE SW
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-2479
Practice Address - Country:US
Practice Address - Phone:507-322-4241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2178237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN187265600Medicaid