Provider Demographics
NPI:1386139004
Name:FRESTEL, BRIEA RAE (LSW, CADC, RYT)
Entity type:Individual
Prefix:
First Name:BRIEA
Middle Name:RAE
Last Name:FRESTEL
Suffix:
Gender:F
Credentials:LSW, CADC, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7902 W 108TH ST
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-2340
Mailing Address - Country:US
Mailing Address - Phone:708-699-5617
Mailing Address - Fax:
Practice Address - Street 1:9611 165TH ST STE 16
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5685
Practice Address - Country:US
Practice Address - Phone:708-846-3726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.102654104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker