Provider Demographics
NPI:1194940007
Name:FREIBURG, SANDRA K (LCSW)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:K
Last Name:FREIBURG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 W MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-1719
Mailing Address - Country:US
Mailing Address - Phone:618-394-5900
Mailing Address - Fax:618-394-5909
Practice Address - Street 1:8601 W MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-1719
Practice Address - Country:US
Practice Address - Phone:618-394-5900
Practice Address - Fax:618-394-5909
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149 0071581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical