Provider Demographics
NPI:1386479160
Name:FREYGANG, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:FREYGANG
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 1:102 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BERNE
Mailing Address - State:IN
Mailing Address - Zip Code:46711-1549
Mailing Address - Country:US
Mailing Address - Phone:260-824-5880
Mailing Address - Fax:
Practice Address - Street 1:102 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BERNE
Practice Address - State:IN
Practice Address - Zip Code:46711-1549
Practice Address - Country:US
Practice Address - Phone:260-824-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1135030103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool