Provider Demographics
NPI:1306882915
Name:FROELICH, THERESA L (DO)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:L
Last Name:FROELICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 40TH ST W
Mailing Address - Street 2:STE 100
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4318
Mailing Address - Country:US
Mailing Address - Phone:253-564-0170
Mailing Address - Fax:
Practice Address - Street 1:7210 40TH ST W
Practice Address - Street 2:STE 100
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4318
Practice Address - Country:US
Practice Address - Phone:253-564-0170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001283207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8372716Medicaid
WA8934254OtherCRIME VICTIMS
WA176262OtherL & I
WA160059867OtherRAILROAD
WA8931181OtherCRIME VICTIMS
WA167394OtherL & I
WAE88216Medicare UPIN
WAAB35339Medicare ID - Type Unspecified
WA8934254OtherCRIME VICTIMS