Provider Demographics
NPI:1366956682
Name:FREUND, JAMIE M
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:M
Last Name:FREUND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54937-1149
Mailing Address - Country:US
Mailing Address - Phone:920-929-8698
Mailing Address - Fax:
Practice Address - Street 1:404 N MAIN ST STE 612
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-4953
Practice Address - Country:US
Practice Address - Phone:920-385-1420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-22
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3752-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health